Aim To investigate the effect of hyperhomocysteinemia in hypertension and with acute ischemic cerebrovascular disease (AICVD) about blood coagulation and fibrinolgsis. Methods 28 cases of essencial hypertension patients, 30 cases of essencial hypertension (EH) and AICVD patients and 21 normal subjects were recruited to the study. Plasma total HCY level was measured using high performance liquid chromatography with fluorescence detection, meanwhile fibrinogen (FIB), tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI)were measured. Results Plasma HCY, t-PA, PAI and FIB level in AICVD patients and EH patients were higher than that in normal subjects. While PAI level in AICVD patients was higher than that in EH patients. And t-PA level in AICVD patiets was lower than that in EH patients. Conclusions There was hyperhomocystieinmia in EH and AICVD patiets. Hyperhomocysteinemia play an important role in coagulation and fibrinolgsis in patient with EH and AICVD.