Abstract Background Ischemic Heart diseases (IHD) are significant causes of morbidity and mortality worldwide with an estimated 9 million deaths each year. Exercise-based Cardiac Rehabilitation (CR) is one of the most important and cost-effective aspects of secondary prevention in patients with IHD. Post-exercise Systolic Blood Pressure Recovery (SBPR) represents an important hemodynamic parameter that is associated with the risk and severity of ischemic artery disease and future cardiovascular events. Aim of the Work The aim of this study is to assess the effect of CR on post-exercise SBPR in patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction. Patients and Methods this study included patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction, presenting to Cardiac Rehabilitation Units. the study included two groups of patients. Study group included Patients on optimal medical treatment who are attending CR sessions, and control group included patients on optimal medical treatment who refused or failed to attend more than 50% of cardiac rehabilitation sessions. SBPR was assessed in each patient before and after the CR program. Results When compared to baseline findings, both groups had statistically significant improvement in LVEF, resting SBP, recovery SBP value and HRR. However, CR group had better improvement in LVEF, lower Resting SBP, lower Peak SBP, Better SBP recovery ratio and better HRR outcomes when compared to the changes in the control group. Conclusions Cardiac Rehabilitation after recent Ischemic coronary artery event can provide significant improvement in Systolic blood pressure recovery and heart rate recovery which are important haemodynamic parameters that are associated with the significance and severity of future cardiovascular events. Abbreviations IHD: Ischemic Heart Disease; CR: Cardiac Rehabilitation; LVEF: Left Ventricular Ejection fraction; SBP: Systolic Blood Pressure