Abstract: Objective To investigate the changes in blood pressure （BP） in patients with acute stroke and the factors related to BP levels. Methods Data were collected prospectively from consecutive stroke inpatients in West China Hospital from March 2002 to March 2004. BP changes of patients within 6 hours from admission to 15 days were observed. Multivariate linear regression model was used to analyze independent factors related to BP at admission. Results Three hundred and eleven patients were included in this study. Admission BP （151±29/90±18）mm Hg was elevated after stroke but decreased rapidly in 12 hours （138±24/81±15）mm Hg with little change thereafter. BP at day 8 reached a stable level （132±18/80±14）mm Hg. Independent factors related to SBP were cardiac disease, known hypertension, impaired conscious level, stroke subtype and age; independent factors related to DBP were stroke type, known hypertension, cardiac disease and diabetes. Conclusion Patients with acute stroke have high BP on hospital admission which decline spontaneously soon afterward and generally does not need urgent pharmacologic treatment. BP is related to several independent factors in acute stroke: known hypertension, cardiac disease, age, conscious and stroke type.