Abstract: Objective To evaluate the influence of metabolic syndrome (MS) on carotid intima-media thickness (IMT) in essential hypertension (EH).Methods A total of 168 young and middle-aged EH patients were divided into MS group (88 cases) and non-MS group (80 cases). Between the two groups were measured and compared IMT,body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP), fasting plasma glucose (FPG),total cholesterol (TC),triglyceride (TG),high-density lipoprotein (HDL-C),low-density lipoprotein (LDL-C) and others. Results Comparison between MS group and non-MS group showed that the level of BMI, FPG, WC, TC, TG, LDL-C and IMT were higher in MS group,P all<0.05. Multiple Logistic regression analysis showed that age,SBP,FPG and LDL-C were the related factors for carotid IMT.Conclusion MS is associated with carotid IMT in young and middle-aged patients with EH. MS and EH may jointly participate in the process of atherosclerosis. Apart from control of blood pressure,correction of metabolic disorders is also necessary in order to prevent complication of atherosclerosis.