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The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBI patients' outcome.The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBI patients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed.The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0 < ΔCPPopt < 10 mm Hg was r = − 0.643 (P < 0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0 < ΔCPPopt < 10 mm Hg was r = − 0.587 (P < 0.001).The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBI patients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10 mm Hg above CPPopt) when CPPopt is in the range of 60–80 mm Hg, and keeping CPP within the range of CPPopt +/− 5 mm Hg when CPPopt is above 80 mm Hg.