Aim To investigate the carotid atherosclerosis risk factors of H-type hypertension. Methods A total of 240 hospitalized patients with primary hypertension from january 2017 to january 2018 were selected. According to the plasma homocysteine(Hcy) level, participators were divided into H-type hypertenion group(H-group, plasma Hcy＞10 μmol/L)with 118 cases and simple group(plasma Hcy≤10 μmol/L) with 122 cases. Patients' general information, biochemical index, carotid intima-media thickness(IMT), carotid atherosclerotic plaques and the condition of carotid stenosis, were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of carotid atherosclerosis in H-group patients. Results Male composition, coronary heart disease history, stroke history, mean systolic blood pressure , pulse pressure, plasma Hcy, low density liporotein cholesterol(LDLC), urea nitrogen(BUN), creatinine(Cr) and uric acid(UA) levels, the detection rate of the carotid IMT, plaque formation, IMT, the plaque number≥3, carotid stenosis >50% in H group were significantly different from simple group(P＜0.05). Multivariate Logistic regression analysis demonstrated that aged, smoking history, high LDL were significantly associated with carotid IMT in H-type hypertension patients, with OR values 1.282(95%CI 1.133~1.451), 663(95%CI 1.200~ 20.669), 4.301(95%CI 1.199~15.434) respectively. Moreover, aged, overweight, high LDL with OR values 1.150(95% CI 1.069~1.238), 3.496(95%CI 1.353~9.033), 1.244(95%CI 1.014~1.526)were significantly associated with plaque formation. Conclusions Aged, smoking history, high LDL were significantly associated with carotid IMT of H-type hypertension patients. Aged, overweight, high LDL had significant effect on the progression of plaque formation.