Aim To investigate the relationships between essential hypertension, hypertensive left ventricular remodeling, serum total cholesterol and the polymorphism of angiotensin Ⅱ type 1 receptor (AT1R) gene. Methods A case-control study was carried out using 148 hypertensive and 164 normotensive subjects. Blood pressure, body mass index, fasting serum glucose, serum total cholesterol (TC) and triglyceride (TG) were measured in all subjects, and LVMI of the hypertensives were measured. The A/c variant at position 1166 of the AT1R gene was identified by polymerase chain reaction and restriction fragment length polymorphism (PCR/RFLP) analysis. The frequencies of AC/CC genotypes and 1166C allele of AT1R gene between hypertensives and normotensives were analyzed by Chi-Square test. Results The frequencies of AC/CC genotypes and 1166C allele of AT1R gene in hypertensives were higher than that in control (AC/CC genotypes 0.203∶0.0104,p<0.05; Callele 0.111∶0.055,p<0.05),the OR is 1.998(95%CI: 1.073～3.581). More statistically significant of C1166 allele frequency and the AC genotype distribution were obtained in subjects with hypercholesterolemia when serum TC level was hierarchically analyzed (AC/CC genotypes 0.260∶0.092,p<0.01; C allele 0.144∶0.046,p<0.01), the OR reach to 3.46(95%CI: 1.29～9.29). AC/CC genotypes were risk factors to hypertension, and such genotypes and TC were risk factors to hypertensive left ventricular remodeling. Conclusions 1166AC/CC genotypes of AT1R gene and TC have additive relation with essential hypertension and hypertensive left ventricular remodeling, the effective control of TC and blood pressure might decrease the damage of target organs.