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Previous studies have shown that optimal blood pressure (BP) control is necessary to outcomes in patients with acute myocardial infarction (AMI). Acute left ventricular MI is a prevalent type of AMI with poor prognosis. We aimed to analyze the associations between BP control in the first 7 days of hospitalization and long-term mortality specific to patients with isolated left ventricular MI. A total of 3108 acute left ventricular MI patients were included in this analysis. The average BP on the first seven days of hospitalization was categorized into 10-mmHg increments. The primary and secondary outcomes were all-cause death and cardiac death, respectively. Cox models were used to assess the association of outcomes with BP during hospitalization. The median length-of-stay was 7 (IQR 6–10) days. The relationship between systolic BP (SBP) or diastolic BP (DBP) followed a U-shaped curve association with outcomes. All-cause mortality was higher in patients with lower SBP (≤90 mmHg) (adjusted hazard ratios (HRs) 7.12, 95% confidence interval (CI) 3.13–16.19; p < 0.001) and DBP (<60 mmHg) (HR 1.76, 95% CI 1.14–2.71; p = 0.011) [reference: 110 < SBP ≤120 mmHg; 70 < DBP ≤ 80 mmHg], respectively. Furthermore, primary outcome was higher in patients with higher SBP (>130 mmHg) (HR 1.51, 95% CI 1.12–2.03; p = 0.007) and DBP (>80 mmHg) (HR 1.61, 95% CI 1.20–2.18; p = 0.002), respectively. Maintaining a SBP from 90 to 130 mmHg and a DBP from 60 to 80 mmHg may be beneficial to patients with acute left ventricular MI in the long run. • Our study was firstly focused on acute left ventricular myocardial infarction (MI). • Mean BP in the 7 days after acute left MI were associated with long-term mortality. • Maintaining SBP (90-130 mmHg) and DBP (60-80 mmHg) in the 7 days after acute left MI may be beneficial. • Our data proposed an valuable hypothesis to better clinical outcomes in acute left ventricular MI. [ABSTRACT FROM AUTHOR]