OBJECTIVE To investigate the association of H-type hypertension with carotid atherosclerotic plaques in Chinese. METHODS This hospital-based large population study included 13192 patients and all the patients were sequentially recruited between May 2010 and May 2013 at the Health Medical Center of the Chinese PLA General Hospital. The subjects were divided into four groups: the H-type of hypertension group, isolated systolic hypertension, simple homocysteine (Hcy) group, and the control group without hypertension and Hcy. Univariate logistic regression analysis was performed to investigate the association of H-type hypertension with the odds of carotid atherosclerotic plaques. RESULTS Among the 13192 subjects, there were 9007 (68.28% of all subjects) patients with hyperhomocysteinemia and 3543 patients with H-type hypertension, which was 26.86% of all subjects and 74.45% of hypertension patients. 34.55% of all subjects (4558) had carotid atherosclerotic plaques. The carotid atherosclerotic plaques positive rate among four groups was significantly different (χ(2) = 647.8988, P = 0.000). The carotid atherosclerotic plaques' positive rate of patients with H-type hypertension was 49.31%, which was significantly higher than the other three groups. Univariate logistic regression analysis results indicated that significant correlations exist between high-Hcy hypertension and carotid atherosclerotic plaques. Incidence of carotid atherosclerotic plaques in H-type hypertension patients was 1.63 times that in patients with isolated systolic hypertension. CONCLUSIONS H-type hypertension is independently associated with higher risk of carotid atherosclerotic plaques. H-type hypertension and Hcy should be the major intervention measures to decrease the incidence of carotid atherosclerotic plaques as well as the stroke in Health Practice Management.