Background: Blood pressure (BP) is elevated in 75% or more of patients with acute stroke and is associated with poor outcomes. Whether to modulate BP in acute stroke has long been debated. With the loss of normal cerebral autoregulation, theoretical concerns are twofold: high BP can lead to cerebral edema, hematoma expansion or hemorrhagic transformation; and low BP can lead to increased cerebral infarction or perihematomal ischemia. Objective: To determine the impact of arterial blood pressure management in acute ischemic stroke on short term outcome and prognosis. Patients and methods: This study included 200 patients diagnosed with ischemic stroke and arrived to Emergency Hospital, Mansoura University over a year from June 2019 to June 2020. The cases were classified into 4 groups according to the systolic BP (SBP) of the cases; control group (SBP < 140 mmHg), group 2 (SBP 140-160 mmHg) group 3 (SBP 160-180 mmHg) and group 4 (SBP 180-200 mmHg). Results: The stroke score (follow up) according to blood pressure groups showed no statistically significant difference between the groups. Regarding the initial CT findings of the cases according to blood pressure groups, fourth group has more changes in CT brain, with a highly statistical significant difference observed between the groups. Conclusion: Elevated blood pressure in patients with stroke were associated with worse outcomes including ICU admission, mortality and duration of hospital admission. CT findings supported these findings as the percent of cases presented with initial infarction and cases who showed hemorrhagic transformation increased with elevation of BP.