To investigate the relationship between blood pressure variability (BPV) and serum vascular endothelial growth factor (VEGF) levels in patients with type I cerebral small vessel disease (CSVD).144 Patients admitted to the Neurology Department of our Hospital between December 2021 and December 2022 were included and categorized into 5 groups according to CSVD burden, which was evaluated based on MRI findings. Group 0-2 were categorized as mild patients, group 3 as moderate patients, group 4 as severe patients. All patients underwent 24-hour ambulatory blood pressure monitoring. Serum samples were collected to measure the concentration of VEGF. The differences of general information, BPV and serum VEGF levels in five groups were compared. Spearman correlation analysis was used to analyze the correlation between total CSVD burden and BPV, as well as total CSVD burden and serum VEGF concentration. Additionally, Pearson correlation analysis was used to explore the correlation between serum VEGF level and BPV.83 males and 61 females with mean age of (67.5±9.9) years were enrolled. Significant differences were observed in age and hypertension history among the five groups (p<0.001). In both mild and severe groups, 24hSBP, 24hSBP-SD, 24hSBP-CV, 24hSBP-ARV, DSBP, DSBP-SD, DSBP-ARV, 24hDBP, 24hDBP-SD, DDBP, NDBP showed a significant positive correlation with the total CSVD burden scores. The differences in serum VEGF concentration among the five groups were statistically significant (P<0.05), with the lowest in group 4 and the highest in group 3. Serum VEGF concentration showed a significant positive correlation with the total CSVD burden scores in patients with mild to moderate CSVD. Pearson's correlation analysis revealed that serum VEGF concentration was significantly and positively correlated with 24hSBP-SD, 24hSBP- ARV, DSBP-SD, DSBP-ARV, and SBP-wSD.VEGF may be associated with the impact of BPV on CSVD patients, and potentially correlated to delaying disease progression.