Aim To investigate the effects of homocysteine on cholesterol and carotid atherosclerotic plaque in patients with cerebral apoplexy induced by hypertension. Methods 149 patients were selected and divided into two groups: 74 patients with hypertension and cerebral apoplexy; 75 patients only with hypertension. The homocysteine(HCY) and cholesterol(TC) level of all these patients were assessed, and at the same time the ultrasound of carotid artery were performed. Results Hypertension with cerebral apoplexy HCY increased more significantly than patients with only hypertension (p<0.05). The incidence of carotid atherosclerotic plaque development in hypertension with cerebral apoplexy was much higher than patients with only hypertension(p<0.05). Conclusions The impair of the artery wall induced by hypertension and higher blood cholesterol were aggravated by hyperhomocysteine which also enhanced the development of cerebral apoplexy. The occurrence of cerebral apoplexy is the results of homocysteine, arteriosclerosis and higher cholesterol.