Aim To explore the association of serum lipoprotein(a)and serum bilirubin with carotid atherosclerosis in patients with hypertension.Methods 124 patients with hypertension whose carotid atherosclerosis were detected by ultrasound were divided into increased IMT group,atheroma group,mild stenosis group,moderate stenosis group,and severe stenosis group.The serum lipoprotein(a)and serum bilirubin levels were measured using automatic biochemistry analysis system.Results Those patients with more severe carotid atherosclerosis had higher serum lipoprotein(a)and lower serum total bilirubin and serum indirect bilirubin.The level of lipoprotein(a)among five groups above(156.7±89.2 mg/L,237.0±170.3 mg/L,324.0±126.0 mg/L,331.9±197.5 mg/L and 346.2±124.0 mg/L)was significant statistical difference(P<0.05).So were serum total bilirubin(12.4±2.6 μmol/L,10.7±1.4 μmol/L,9.1±1.0 μmol/L,8.1±0.9 μmol/L and 7.1±0.8 μmol/L)and serum indirect bilirubin(9.1±2.4 μmol/L,7.4±1.5 μmol/L,5.9±1.2 μmol/L,4.9±0.8 μmol/L and 3.9±0.8 μmol/L).While Serum direct bilirubin showed no statistical difference between five groups(P>0.05).Otal and indirect serum bilirubin correlated negatively with lipoprotein(a)(r=-0.332 and-0.331,P<0.01 for all).Conclusion High serum lipoprotein(a)and low serum bilirubin may be closely related to atherosclerosis in patients with hypertension.