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Background / Purpose: Pulse pressure (PP) is related to cardiac function, arterial stiffness, fluid status and vascular events. The impact of PP on stroke outcome remains to be delineated. The present study aimed to explore the prognostic role of admission PP in patients with acute ischemic stroke (AIS) based on a nationwide stroke registry.Methods: We evaluated the association between PP on admission and outcome at 3 months after stroke in AIS patients registered in the Taiwan Stroke Registry, including 56 academic and community hospitals, during 2006~2013.Unfavorable outcome was defined as modified Rankin Scale of 3~6 at 3 months after stroke.Results: Of 33,530 patients (female, 40.6%; mean age, 68.8±13.3 years) with AIS, PP on admission had a “reversed J-curve” association with unfavorable outcome. After adjustment for clinical variables including AIS subtypes, initial National Institutes of Health Stroke Scale, systolic and diastolic blood pressure on admission, PP <50 mmHg remained associated with unfavorable outcome (p<0.0001). Compared to patients with PP 50-69 mmHg, the odds ratios of unfavorable outcome were 1.24 (95% confidence interval, 1.13-1.36) with PP 30-49 mmHg and 1.85 (95% confidence interval, 1.50-2.28) with PP<30 mmHg. Furthermore, the prognostic impact of admission PP was similar across all AIS subtypes.Conclusion: Low PP on admission carries an unfavorable outcome in patients with AIS.