Aim To investigate the relationship between paraoxonase-1(PON1) polymorphisms and essential hypertension with carotid atherosclerosis. Methods The study comprised 527 participants who were divided into two groups: essential hypertension with carotid atherosclerosis(case group,n=321) and essential hypertension without carotid atherosclerosis(control group,n=206).The case group was consisted of Han people(n=230) and Uighur people(n=91).The control group was consisted of Han people(n=123) and Uighur people(n=83).Genotypes were detected by polymerase chain reactions followed by restriction analysis with specific endonucleases and their frequencies were determined. Results The M allele frequency of the PON1 L55M gene exihibited a significant difference between case group and control group in Han people(χ2=4.038,P>=0.044).LDL exhibited a difference in Han people between LL genotype and M allele carriers(P>=0.029).The M allele might be a risk factor for carotid atherosclerosis in Han people(P>=0.016). Conclusion The single nucleotide polymorphism of PON1 L55M is probably associated with carotid atherosclerosis in essential hypertension people of Chinese Han population in Xinjiang.The M allele might be a risk factor.