Pumped hydro energy storage (PHES) is currently the only proven large-scale energy storage technology. Frequent changes between pump and turbine operations pose significant challenges in the design of a pump-turbine runner with high efficiency and stability, especially for ultrahigh-head reversible pump-turbine runners. In the present paper, a multiobjective optimization design system is used to develop an ultrahigh-head runner with good overall performance. An optimum configuration was selected from the optimization results. The effects of key design parameters--namely blade loading and blade lean--were then investigated in order to determine their effects on runner efficiency and cavitation characteristics. The paper highlights the guidelines for application of inverse design method to high-head reversible pump-turbine runners. Middle-loaded blade loading distribution on the hub, back-loaded distribution on the shroud, and large positive blade lean angle on the high pressure side are good for the improvement of runner power performance. The cavitation characteristic is mainly influenced by the blade loading distribution near the low pressure side, and large blade lean angles have a negative impact on runner cavitation characteristics.