Abstract: AIM: To explore the relationship between leptin and intima-media thickness (IMT) of the carotid wall and to observe the effects of leptin on the development of arterial atherosclerosis in elderly hypertensive patients. METHODS: This study included 111 patients >60 years of age with hypertension (study group) and 43 healthy elderly patients (control group). Blood pressure, fasting serum leptin, fasting glucose and lipids were measured, and waist-to-hip ratio (WHR) and body mass index (BMI) were calculated in all subjects. IMT of carotid artery was quantified by high-resolution ultrasound imaging. Difference between groups was compared and the correlation was analyzed in the study group. RESULTS: A significant difference was found in systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, leptin and IMT between groups (P<0.01). In the study group, leptin level was correlated with IMT level and IMT level was correlated positively with age, WHR and leptin (r=0.38, r=0.15, r=0.84, respectively)(all P<0.01). CONCLUSION: Hypertensive patients have higher levels of leptin and IMT than controls. Leptin level is significantly correlated with IMT in the study group.