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Objective: To investigate the correlation between the pulse pressure (PP) and functional outcome in acute middle cerebral arterial (MCA) ischemic stroke.Method: We reviewed the medical records of 52 first-ever hemiplegic MCA ischemic stroke patients (age 61.5±9.7 years; 35 men, 17 women). Functional outcomes were evaluated with Korean-modified Barthel index (K-MBI), functional independence measure (FIM), Korean-national institutes of health stroke scale (K-NIHSS), and Korean-mini mental state examination (K-MMSE) on 3 days and 3 months after the onset of stroke in all the subjects. The PP was measured six times within initial 24 hours after stroke onset and then the highest PP was selected for the analysis.Results: The degree of PP elevation revealed the significant correlations with male gender, over the age of 55 years, diabetes mellitus, and current smoking history, respectively (p<0.05). In TOAST (Trial Org 10172 in Acute Stroke Treatment) classification, the large artery atherosclerosis group showed significantly the higher PP rather than the other groups (p<0.05). There were inverse correlations between the PP and each of FIM and K-MBI scores on 3 months after stroke onset (p=0.000, 0.009; r=−0.479, −0.358). There was an inverse correlation between the PP and the change of FIM (p=0.000, r=−0.532).Conclusion: The PP within initial 24 hours after stroke onset revealed significant correlation with functional outcome. The management for the proper PP gives the favorable effect on the functional outcome in acute MCA territory ischemic stroke

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