Abstract: Objective To investigate the association between components of high density lipoprotein- cholesterol (HDL-C) and Apolipoprotein A-I (ApoA-I) and carotid atherosclerosis in patients with hypertension. Methods Two hundred and eight consecutive patients diagnosed with hypertension were enrolled in this study, and they were divided into atherosclerosis group and nonatherosclerosis group. Plasma ApoA-I and HDL-C were measured in all patients. Logistic regression analysis was used to assess independent predictors for presence of carotid atherosclerosis in patients with hypertension. Results The concentrations of plasma ApoA-I and HDL-C were significantly lower in atherosclerosis group than non-atherosclerosis groupApoA-I, (1.34±0.28) ng/L vs (1.48±0.22) ng/L, P< 0.05; HDL-C, (0.93±0.24) pmol/L vs (1.14±0.37) pmol/L, P< 0.05. There was a negative correlation between ApoA-I and carotid atherosclerosis in hypertension after further adjustment for HDL-C (OR:0.130, 95% CI:0.025-0.677, P=0.015), whereas the association between HDL-C and carotid atherosclerosis was noticeably absent after inclusion of ApoA-Iin the model. Conclusion HDL-C and ApoA-I are protective factors of carotid atherosclerosis in patients with hypertension, however in comparison with HDL-C, ApoA-I is more likely to predict carotid atherosclerosis in hypertension.