Introduction: Uncertainty persists over the optimal management of blood pressure (BP) in the early phase of acute ischemic stroke (AIS). This study aims to determine the safety and effects of intensive BP lowering on cerebral blood flow and functional outcomes in AIS patients treated with intravenous thrombolysis. Methods: In a randomized controlled trial, AIS patients with a systolic BP of 160-180mmHg were randomized to early intensive BP lowering (systolic target range 140-160mmHg) or guideline-based BP management (systolic range 160-180mmHg) during first 72-hours using primarily intravenous labetalol. All study subjects underwent CT perfusion at baseline, 24 and 72-hours post-randomization to evaluate change in cerebral hemodynamics. Clinical outcome was assessed using a dichotomized modified Rankin scale (scores 0-1 as excellent outcome versus scores 2-6 as poor outcome) at 90 days. Results: Of the 48 recruited patients, 25 (52%) were assigned to the early intensive BP lowering arm and 23 (48%) to the guideline-based BP management arm. Excellent functional outcome at 90 days were similar in the 2 arms- 56% in the early intensive BP lowering arm and 61% in the standard therapy arm. There were no significant differences in the baseline, 24 and 72-hour CT perfusion cerebral hemodynamic parameters or symptomatic intracranial hemorrhage between the 2 study arms. Conclusions: In the early phase of AIS, intensive BP lowering appears to be a safe strategy. Large randomized controlled trials are needed to confirm our study findings.