The study analyzed data from the International Stroke Trial (IST) to explore the relationship between systolic blood pressure (SBP) and clinical outcomes in patients with acute ischemic stroke. The analysis included 17,398 patients with confirmed ischemic stroke, with a single measurement of SBP taken immediately before randomization. The primary outcomes were early death within 14 days and death or dependency at 6 months. Key findings include: 1. **U-shaped Relationship**: A U-shaped relationship was found between baseline SBP and both early death and late death or dependency. Early death increased by 17.9% for every 10 mm Hg below 150 mm Hg, and by 3.8% for every 10 mm Hg above 150 mm Hg. 2. **Recurrent Ischemic Stroke**: The rate of recurrent ischemic stroke within 14 days increased by 4.2% for every 10-mm Hg increase in SBP, regardless of whether the stroke was fatal or nonfatal. 3. **Cerebral Edema**: Death resulting from presumed cerebral edema was independently associated with high SBP (P=0.004). 4. **Low SBP**: Low SBP (below 120 mm Hg) was associated with severe clinical stroke (total anterior circulation syndrome) and an excess of deaths from coronary heart disease (P=0.002). The study concluded that both high and low blood pressure are independent prognostic factors for poor outcomes in acute stroke patients. High blood pressure is linked to increased rates of early recurrence and death from cerebral edema, while low blood pressure is associated with an increased risk of coronary heart disease events. The occurrence of symptomatic intracranial hemorrhage within 14 days was not found to be related to SBP.The study analyzed data from the International Stroke Trial (IST) to explore the relationship between systolic blood pressure (SBP) and clinical outcomes in patients with acute ischemic stroke. The analysis included 17,398 patients with confirmed ischemic stroke, with a single measurement of SBP taken immediately before randomization. The primary outcomes were early death within 14 days and death or dependency at 6 months. Key findings include: 1. **U-shaped Relationship**: A U-shaped relationship was found between baseline SBP and both early death and late death or dependency. Early death increased by 17.9% for every 10 mm Hg below 150 mm Hg, and by 3.8% for every 10 mm Hg above 150 mm Hg. 2. **Recurrent Ischemic Stroke**: The rate of recurrent ischemic stroke within 14 days increased by 4.2% for every 10-mm Hg increase in SBP, regardless of whether the stroke was fatal or nonfatal. 3. **Cerebral Edema**: Death resulting from presumed cerebral edema was independently associated with high SBP (P=0.004). 4. **Low SBP**: Low SBP (below 120 mm Hg) was associated with severe clinical stroke (total anterior circulation syndrome) and an excess of deaths from coronary heart disease (P=0.002). The study concluded that both high and low blood pressure are independent prognostic factors for poor outcomes in acute stroke patients. High blood pressure is linked to increased rates of early recurrence and death from cerebral edema, while low blood pressure is associated with an increased risk of coronary heart disease events. The occurrence of symptomatic intracranial hemorrhage within 14 days was not found to be related to SBP.