Objective To determine the effect of early antihypertensive therapy on 1-year outcome of the acute ischemic stroke patients categorized by Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods A total of 597 hypertension patients with image-diagnosed ischemic stroke (without thrombolysis treatment) within 48 h of disease onset admitted to Tai′an Branch of Chinese PLA Hospital No.960 and Feicheng People′s Hospital from August 2009 to May 2013 were recruited in this study. According to TOAST classification, they were assigned into large artery atherosclerosis subtype (LAA group, n=261), cardio-embolism subtype (CE group, n=91), small artery occlusion subtypes (SAO group, n=225) and other subtypes (n=20). Then every subtype group was further divided into the antihypertension (AH) treatment subgroup and the non-antihypertension (non-AH) treatment subgroup, with those of LAA group containing 126 cases in the former and 135 cases in the latter subgroups, those of CE group containing 46 and 45 cases, those of SAO group containing 115 and 110 cases, and those of other subtypes containing 7 and 13 cases, respectively. In all the AH subgroups, blood pressure must be decreased by 10% to 20% within 24 h of enrollment. The mortality, mortality/disability rate and recurrence rate were evaluated at one year after discharge. SPSS statistics 20.0 software was used for statistical analysis, and Student′s t test or Chi-square test was employed for comparison between the two groups. Results The results of 1-year follow-up showedthat there were no statistical differences in mortality, mortality/disability rate and recurrence rate between the AH and non-AH subgroups from the LAA, SAO and other subtypes groups (P>0.05). In the CE group, the 1-year mortality/disability rate was significantly lower in the AH than the non-AH treatment subgroups (45.6% vs 66.7%, P<0.05), while no such differences were seen in 1-year mortality and stroke recurrence rate between the two subgroups (P>0.05). Conclusion Antihypertensive therapy in the acute phase after ischemic stroke shows no obvious effect on 1-year outcome in the LAA and SAO patients, but it can effectively reduce the 1-year mortality/disability rate for the CE patients.