Aim To assess the extent of atherosclerosis in elderly hypertensive patients. Methods With high resolution ultrasound, not only intima-media thickness (IMT), plaque of carotid arteries, but also endothelium-dependent relaxing function were measured in 82 subjects, consisted of 62 patients with essential hypertension and 20 controls. Results IMTs of carotid arteries were higher in hypertensive patients than those in normal subjects (P<0.05). There was an increasing trend for IMT with the severity of plaque. Flow mediated dialtation in the groups with essential hypertension was much reduced compared with the control group (P<0.05). Conclusions Increases in IMT of carotid arteries and impairment of endothelium-dependent vasolidation are related to atherosclerosis in early stage in elderly hypertensive patients.