Aim To investigate the correlation between carotid atherosclerosis and serum 25-hydroxyvitamin D （25（OH）D） levels of elderly hypertensive patients. Methods Carotid intima-media thickness（IMT） were detected by ultrasound in the elderly hypertensive patients from Ningbo No.2 hospital from May 2012 to December 2012. According carotid carotid IMT, 180 cases of elderly patients with hypertension were divided into normal carotid artery group （60 cases, control group）, carotid intimal thickening group （60 cases）, carotid plaque group （60 cases）. Serum 25（OH）D levels were measured by ELISA in three groups, and the relationship between carotid IMT and serum 25（OH）D levels was analysed. Results Serum 25（OH）D levels were lower in carotid artery plaque group and carotid intimal thickening group than in normal carotid artery group（P<0.05）, and it was lower in carotid artery plaque group than in carotid intimal thickening group（P<0.05）, and the differences were statistically significant. Conclusion Low serum 25（OH）D levels in elderly hypertensive patients increased risk of carotid atherosclerosis, the mesurement of serum 25（OH）D levels help predicting the degree of carotid atherosclerosis.