Abstract: Objective To explore the relationship of serum uric acid (UA) with left ventricular hypertrophy and geometry in elderly males with essential hypertension. Methods A retrospective study including 295 elderly males with essential hypertension from June 2008 to October 2011 in Chinese PLA General Hospital were enrolled in this study. Patients were divided into hyperuricemia group (n=160) and non-hyperuricemia group (n=135), or were divided into three groups according to the serum UA levels on admission:low-level group (123-304 μmol/L) with 101 cases, mid-level group (304-386 μmol/L) with 111 cases and high-level group (386-800 μmol/L) with 83 cases, and all the cases received echocardiography examination to evaluate left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular mass (LVM), left ventricular mass index (LVMI) and relative wall thickness (RWT). Furthermore, all the cases were divided into four groups according to ventricular geometry:normal geometry, concentric remodeling, eccentric left ventricular hypertrophy and concentric left ventricular hypertrophy, and serum UA levels were measured and compared between groups. Results Compared with non-hyperuricemia group, IVST and LVMI remarkably increased in the hyperuricemia group (11.24±1.49 mm vs 10.65±1.32 mm, P< 0.01; 111.70±3.62 vs 105.81±4.79, P< 0.05). Values of LVM (202.39±7.23 g vs 189.10±8.69 g, P< 0.05), LVMI (111.83±4.28 vs 105.12±4.90, P< 0.05), RWT (0.434±0.057 vs 0.425±0.075, P< 0.01) in the mid-level group and LVM (209.34±5.65 g vs 189.10±8.69 g, P< 0.01), RWT (0.446±0.094 vs 0.425±0.075, P< 0.05) in the high-level group were significantly higher than those in low-level group. Compared with mid-level group, LVEDD (50.03±6.53 mm vs 49.28±6.11 mm, P< 0.05), LVM (209.34±5.65 g vs 202.39±7.23 g, P< 0.01) and RWT (0.446±0.094 vs 0.434±0.057, P< 0.05) significantly increased in the high-level group. Additionally, compared with normal geometry group and concentric remodeling group, serum UA level in concentric ventricular hypertrophy group significantly elevated (406.52±4.71μmmol/L vs 352.57±3.72 μmmol/L, P< 0.01; 406.52±4.71μmmol/L vs 357.66±4.64μmmol/L, P< 0.01). Binary Logistic regression analysis showed that serum UA level was strong and independently associated with left ventricular hypertrophy in elderly males with essential hypertension (OR:1.426; 95% CI:1.031-2.110). Conclusion Serum UA level is correlated with left ventricular hypertrophy and ventricular remodeling, and UA is valuable in predicting the development of left ventricular hypertrophy in elderly male patients with essential hypertension.