Aim To assess the relationship between serum high-sensitivity C-reactive protein(hs-CRP) and silent myocardial ischemia(SMI) in essential hypertension. Methods We designed a cross-sectional study with 157 mild or moderate essential hypertension patients having no known coronary heart disease(CHD).Ischemia was assessed by exercise treadmill testing and coronary arteriography.157 patients were separated into SMI group(n=69) and control group(n=88).Blood was collected for measurement of hs-CRP concentrations in all enrolled patients. Results A total of 69 patients(43.9%) was found to have SMI.Compared with control group,higher hs-CRP levels were observed in SMI group (3.13± 1.55) mg/L vs(1.33±0.91) mg/L,P><0.001].Logistic regression analysis revealed gender(Or= 9.56,95% CI=2.57~35.60,P>=0.001),hs-CRP(Or=4.54,95%CI=2.47~8.35,P><0.001) and family history of CHD(Or=0.11,95% CI=0.03~0.34,P><0.001) to be associated with greater risk of SMI.A significantly increasing trend of SMI was observed with increasing serum levels of hs-CRP(P><0.01). Conclusion Hs-CRP was associated with SMI.Essential hypertension with SMI are at high risk and need aggressive treatment.Hs-CRP might help to detect SMI in patients with essential hypertension.