Aim To explore the value of early blood pressure variability (BPV) in predicting the risk of symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Methods AIS patients were collected who received recombinant tissue plasminogen activator IVT within 4.5 hours of onset from 2012 to 2016 with complete clinical data. According to skull CT or MRI findings and NIHSS scores within 48 hours after IVT therapy, the patients were divided into sICH group (22 cases) and non-sICH group (157 cases). The differences of sICH risk factors between the two groups were analyzed by single factor t test, χ² test and multivariate Logistic regression analysis. The 24-hour systolic blood pressure standard deviation (24hSBPsd) and 24-hour diastolic blood pressure standard deviation (24hDBPsd) were further divided into four groups in quartiles, with the lowest quartile group as the reference group, and the rest groups were compared with the reference group, respectively. Results Univariate analysis showed that age, fibrinogen (FIB), smoking history, 24hSBPsd and 24hDBPsd in sICH group were higher than those in non-sICH group (all P＜0.05). Multivariate Logistic regression analysis showed that age (OR 3.7,5% CI 1.089-8.920), smoking history (OR 2.3,5% CI 1.042-8.257) and 24hSBPsd (OR 4.5,5% CI 1.397-12.237) in sICH group were still higher than those in non-sICH group (all P＜0.05); There was no significant difference in FIB and 24hDBPsd between the two groups (P＞0.05). After adjusting for risk factors of age and smoking history, the risks of sICH in 24hSBPsd and 24hDBPsd of the highest quartile group were 10.882 times (95%CI 2.088-56.717) and 6.025 times (95%CI 1.550-23.417) higher than those of the lowest quartile group, respectively, and the differences were statistically sigificant (P＜0.05). Conclusion The higher the early BPV, the higher the risk of sICH after IVT, and the more obvious the influence of systolic blood pressure variability.