Aim To investigate the relationship between coronary atherosclerosis and aortic pulse pressure(APP) in patients with essential hypertension. Methods A total of 300 untreated hypertensive patients were recruited for a first diagnostic coronary angiogram.The following data were collected: invasive intra-aortic systolic and diastolic blood pressure(BP),APP,extent of coronary artery disease,clinical and laboratory characteristics. Results In the whole population,aortic systolic BP and APP were significantly higher in CAD group than no CAD group(150.3±26.5 mm Hg vs 145.6±23.3 mm Hg,p<0.05) and(77.1±22.7 mm Hg vs.70.4±19.3 mm Hg,p<0.05).The ratio of stroke volume(SV) to APP was markedly lower in CAD group(1.15±0.44 mL/mmHg vs 1.31±0.50 mL/mmHg,p<0.05).In addition,CAD group is characterized by higher values of fasting glucose(122.3±24.0 mg/dL vs 95.6±24.4 mg/dL,p<0.01) and serum creatinine(1.06±0.19 mg/dL vs.0.99±0.14 mg/dL,p<0.01),and lower values of HDL cholesterol(47.7±11.7 mg/dL vs.54.9±15.6 mg/dL,p<0.01). Conclusions Atherosclerosis may further aggravate the aortic stiffness in hypertensive patients,therefore result in higher aortic PP.Atherosclerosis can also impair the renal function of hypertensive patients,and bring lipid metabolic disorder.