Objective To investigate the clinical features of patients with acute ischemic stroke and primary aldosteronism (PA).Methods A total of 403 patients with acute ischemic stroke were enrolled, and according to the presence or absence of PA, they were divided into PA group with 19 patients and non-PA group with 384 patients. Related clinical data were compared between the two groups.Results Compared with the non-PA group, the PA group had significantly higher systolic pressure and diastolic pressure on admission (P=0.012 and P=0.009) and a significantly lower serum potassium level (P<0.001), and only 6 patients in the PA group (31.6%) had a serum potassium level below the lower limit of normal (3.5 mmol/L). There was no significant difference between the two groups in the proportion of patients with each TOAST type.Conclusions There is a high prevalence rate of PA among patients with acute ischemic stroke. Screening should be performed for the patients with acute ischemic stroke who have the risk factors for PA such as sustained or refractory hypertension and hypokalemia.