Purpose: We investigated how BP is changed over elapsed time according to the perfusion status at acute stage of ischemic stroke. Methods: Patients arrived within 24 hours of symptom onset and have symptomatic occlusion at MCA and ICA were consecutively identified. Among them, we included those were not eligible or failed for recanalization therapy at acute stage. According to the occluded site and perfusion lesion volume, they were dichotomized into upper one-third (large PLV) and others (small-to-medium PLV). For the first consecutive 5 days, daily BP parameters of followings: mean, maximum-minimum and standard deviation (SD) between groups were compared using repeated measures ANOVA. Results: Of enrolled 129 subjects (mean age, 69.3 ± 12.7 years-old and median NIHSS score, 6), cut-offs of large PLV were 143 ml for MCA and 232 ml for ICA. At the day of hospital arrival, mean, maximum-minimum and SD of systolic BP were 136.8, 55.6 and 14.4 mmHg and those at 5th day were 136.2, 32.9 and 11.8 mmHg, respectively. Patients with large PLV were significantly associated with higher maximum-minimum and SD compared to those with small-to-medium PLV (P < 0.001) not averaged value with adjustments for age and baseline NIHSS score (Figure 1). Conclusion: Perfusion status at acute stage of ischemic stroke would be related with day-to-day change of BP variability.