Aim To explore the relationship between the abnormality of postprandial triglyceride (TG) metabolism and the intimal medial thickness (IMT) in patients with essential hypertension (EH). Methods In 38 EH patients and 30 healthy subjects, TG, high density lipoprotein (HDL), total cholesterol (TC), glucose before and 2,4,6,8 hours after a standardized fat loading and low density lipoprotein (LDL) in fasting serum were measured. Triglyceride peak response (TGPR) and the triglyceride area under curve (TG AUC) over 8 hours were calculated and the index was regarded to show the response level of the subjects to the fat loading. IMT of carotid was detected through two dimensional ultrasound before the fat loading. Results EH patients had higher TGPR (4.68±1.74 vs 1.76±0.64 mmol/L) and TG AUC(23.59±6.48 vs 9.56±3.38 mmol/L,8h)(p<0.05). The net increasing value and net increasing rate of serum TG concentration at 6,8 hours after fat loading in EH group were higher than that of control group. The net increasing value at the two time points of 2,4,6,8 hours were also higher in the patients. Besides,IMT of carotid in EH was higher than that in control group (0.767±0.150 vs 0.603±0.050, P=0.009). From regression analysis, IMT was positively correlated with TG AUC,age,TGPR,BMI (r=0.497,0.448,0.382,0.352,p< 0.05 ), while negatively correlated with fasting HDL level. Conclusions EH patients accompanied with the abnormality of postprandial TG metabolism was correlated with IMT of carotid.