To investigate the relationship between common carotid artery diameter (CCA-D) and target organ damage (TOD) in essential hypertension. A total of 200 essential hypertensive patients were enrolled (mean age 62.5 ± 9.5, men 59.0%) and were classified into two groups by the height-adjusted mean median of CCA-D: patients with CCA-D/height less than 3.905 mm/m (n = 100, 50%) and patients with CCA-D/height more than 3.905 mm/m (n = 100, 50%). Patients with CCA-D/height more than 3.905 mm/m have higher left ventricular mass index (LVMI) (P < 0.001) and higher prevalence of left ventricular hypertrophy (LVH) (P < 0.001), higher mean common carotid intima-media thickness (P = 0.008) and higher prevalence of carotid artery sclerosis (P = 0.03), higher pulse wave velocity (PWV) (P < 0.001) and higher prevalence of increased arterial stiffness (P = 0.01), higher urinary albumin/creatinine ratio (P = 0.001) and higher prevalence of microalbuminuria (P = 0.02) and greater number of TODs (P < 0.001) compared with the patients with CCA-D/height less than 3.905 mm/m. CCA-D was significantly correlated with LVMI, PWV and logarithmically transformed urinary albumin/creatinine ratio (r = 0.299, P < 0.001; r = 0.212, P = 0.007; r = 0.224, P = 0.005, respectively) after adjusting for cardiovascular risk factors. Multivariable stepwise linear regression analysis showed that number of TODs as well as individual TOD, including LVMI, PWV and logarithmically transformed urinary albumin/creatinine ratio, were independently correlated to height-adjusted mean CCA-D (all P < 0.05). Height-adjusted mean CCA-D was an independent risk factor for individual TOD, including LVMI, PWV and urinary albumin/creatinine ratio, as well as overall number of TODs in essential hypertension.