Abstract: A retrospective analysis was conducted on a 64-year-old male patient with lacunar infarction. Clinical progression, thrombolytic therapy, auxiliary examinations, continuous blood pressure monitoring, and pharmacological interventions were reviewed. Particular attention was given to blood pressure control before and after thrombolysis, acute-phase management strategies, and the impact of antihypertensive therapy on blood pressure variability (BPV) and time in therapeutic range (TTR). The findings were then discussed in light of relevant domestic and international guidelines and the existing literature. The patient presented within 2 hours of symptom onset and received intravenous alteplase. The peak blood pressure in the acute phase was 182/88 mmHg. Antihypertensive therapy was withheld during the first 72 hours post-thrombolysis to preserve perfusion to the ischemic penumbra. Persistent hypertension ( ≥ 140/90 mmHg) and echocardiographic evidence of left atrial enlargement after 72 hours prompted initiation of amlodipine. Following dose escalation from 5 mg/d to 10 mg/d, blood pressure gradually approached target levels, with a mean inpatient blood pressure of 140/82 mmHg. At the 1-month follow-up, the patient's average home blood pressure was 136/78 mmHg, with a coefficient of variation for systolic blood pressure of 3.3% and a TTR of 50%. Neurological function showed marked improvement. No recurrent stroke occurred during 1-year follow-up, and blood pressure remained stable at approximately 135/85 mmHg. This case indicates that dynamic blood pressure monitoring, attention to BPV and TTR, and timely initiation of stable, long-acting antihypertensive therapy may help optimize short- and long-term outcomes in patients with acute ischemic stroke.