Abstract: Objective To analyze the relationship between blood pressure variability within the first 24 hours after admission and discharge outcome in acute ischemic stroke patients with large-artery atherosclerosis. Methods First 24-hour blood pressure was monitored from April 2016 to March 2016 in patients after admission. Modified rankin scale scores ≥ 3 was considered poor discharge outcome. Standard deviation presented blood pressure variability, patients were divided into groups according to critical values of standard deviation of blood pressure variability. The relationship between blood pressure vriability and discharge outcome was analyzed by multivariate Logistic regression analysis. Results A total of 320 patients were included. Patients with greater systolic blood pressure variability had high risk of poor discharge outcome, the standard deviation (SD) ≥ 14 in systolic blood pressure (SBP) was associated with discharge outcome, adjusted OR(95% CI) was 1.808(1.059-3.087), the SD ≥ 15 in SBP was associated with discharge outcome, adjusted OR(95% CI) was 1.682(1.003-2.819). There was no relation between diastolic blood pressure variability within 24 hours after admission and discharge outcome, the SD ≥ 10 in DBP was not associated with discharge outcome, adjusted OR(95% CI) was 1.273(0.757-2.139), the SD ≥ 11 in DBP also was not associated with discharge outcome, adjusted OR(95% CI) was 1.439(0.857-2.418). Conclusions Systolic blood pressure variability within the first 24 hours after admission was associated with poor discharge outcome in acute ischemic stroke patients with large-artery atherosclerosis.