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Objective: To investigate the therapeutic effect of Buyang Huanwu Decoction on hypertension complicated with cerebral infarction and its effect on serum phosphatidylinositol-3 kinase (PI3K)/serine threonine protein kinase (AKT) signal pathway. Methods: 100 patients with hypertension complicated with cerebral infarction in our hospital from February 2018 to February 2021 were selected and randomly divided into observation group (Buyang Huanwu Decoction Combined with conventional Western Medicine, 50 cases) and control group (conventional western medicine, 50 cases), all for 3 weeks. The clinical total effective rate of the two groups 3 weeks after treatment was compared, the blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], neurological function and activities of daily living [national Institutes of health neurological deficit scale (NIHSS), Barthel Index], hemorheological indexes (plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity, fibrin), mean blood flow velocity (VM)] and PI3K/AKT signaling pathway related proteins before and 3 weeks after treatment were compared between the two groups. Results:The total effective rate of the control group was 74.00%, which was lower than 92.00% of the observation group (P<0.05). Compared with the control group, SBP, DBP and NIHSS scores were lower and Barthel index was higher in the observation group after 3 weeks of treatment (P<0.05). Compared with the control group, the plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity and fibrin level of the observation group were lower after 3 weeks of treatment (P<0.05). Compared with the control group, PI3K, AKT protein levels in the observation group were lower after 3 weeks of treatment (P<0.05). Conclusion: Buyang Huanwu Decoction can effectively improve hemorheology, blood pressure in patients with hypertension complicated with cerebral infarction, reduce nerve injury, improve activities of daily living, and down regulate PI3K/AKT signal pathway related protein levels. [ABSTRACT FROM AUTHOR]