Aim To evaluate the relation between the systolic blood pressure and carotid atherosclerosis in older hypertensive patients. Methods 120 cases of older hypertensive patients were selected from May 2007 to October 2008.These patients were divided into 2 groups.There were 60 cases with isolated systolic hypertension in the first group and 60 cases with non-isolated systolic hypertension in the second group.Then the degree of carotid atherosclerosis was compared between two groups through ultrasonic testing. Results There were significant differences in incidence of carotid intima-media thickening and atherosclerosis between isolated systolic hypertensive group and non-isolated systolic hypertensive group. Conclusion The systolic blood pressure indicates stronger signification than the diastolic blood pressure in atherosclerosis.