【Abstract】 Objective To investigate the correlation between blood pressure variability and carotid atherosclerotic plaque in patients with acute anterior circulation cerebral infarction and provide evidence for clinical application. Methods 236 patients with acute cerebral infarction were divided into carotid artery stenosis group (206 cases) and non carotid artery stenosis group (30 cases). According to the degree of carotid artery stenosis, the patients in the carotid artery stenosis group were divided into < 50% group (carotid artery stenosis more than 50%, 142 cases) and stenosis more than ≦50% group (carotid artery stenosis less than 50%, 64 cases). The patients were detected with ultrasound examination and ambulatory blood pressure monitoring.Results The nSSD, dDSD and dSSD of stenosis group were significantly higher than that of nonstenosis group (P<0.05). The circadian rhythm of blood pressure of stenosis group and nonstenosis group existed obvious difference. The difference was statistical significance (P<0.05). The nSSD, dDSD, dSSD of <50% stenosis group were significantly lower than that of ≦ 50% group (P<0.05). The degree of circadian rhythm of stenosis <50% group and ≦50% group was significant difference (P<0.05).Conclusion The acute anterior circulation cerebral infarction blood pressure variability and carotid atherosclerosis is closely related to the clinical by correcting the abnormal rhythm. Improving the blood pressure variability can play a role in the prevention and control of atherosclerosis.