Aim To explore the correlation between carotid atherosclerosis (CAS) and neutrophil/lymphocyte ratio (NLR) in patients with early morning hypertension, and to construct a line chart model to predict the risk of CAS in patients with hypertension in the morning. Methods 255 patients with early morning hypertension hospitalized in the Affiliated Hospital of Chengde Medical College from October 2019 to November 2022 were collected, and their basic data, blood routine and blood biochemical indexes were collected. All selected patients need to improve 24-hour ambulatory blood pressure monitoring and carotid artery color ultrasound detection. According to the presence or absence of CAS, all selected patients were divided into morning hypertension with CAS group (n＝197) and morning hypertension without CAS group (n＝58). Multivariate Logistic regression analysis was used to explore the risk factors of early morning hypertension with CAS, and to construct and verify an individual line chart model to predict the risk of early morning hypertension patients with CAS. Results The age, NLR, neutrophils (NE), monocytes (MO), white blood cell (WBC), total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDLC) increased in the early morning hypertension with CAS group compared with those in the morning hypertension group without CAS, while the HDLC decreased(P＜0.05). The results of multivariate Logistic regression analysis showed that the age, NLR and TC were higher in the early morning hypertension with CAS group than those in the early morning hypertension without CAS group, while HDLC was lower; Age, NLR and TC were independent risk factors of early morning hypertension with CAS, while HDLC was independent protective factors of morning hypertension with CAS. Based on the results of multivariate Logistic regression analysis, an individualized line chart model for predicting early morning hypertension with CAS was constructed. The area under the ROC curve of the line chart model was 0.853 (95%CI:0.802～0.904, P＜0.01). The result of Hosmer Lemeshow fit test was χ²=1.665 (P＞0.05). Conclusions There was a positive correlation between NLR and morning hypertension with CAS, and NLR was an independent risk factor for morning hypertension with CAS. The individualized line chart model based on age, NLR, TC and HDLC can effectively predict the risk of hypertension with CAS in the early morning, which provides a theoretical basis for early detection and prevention of atherosclerosis.