Abstract: Objective To study the relationship between ambulatory pulse pressure （APP） and carotid intima media thickness（IMT） in the very old patients （≥80 years old） with essential hypertension（EH）. Methods According to their APP measured with ambulatory blood pressure monitoring（ABPM）,eighty-two very old patients with EH were divided into two groups:APP＜60 mmHg group（n=40） and APP≥60 mmHg group（n=42）. The carotid IMT were measured using B-mode Doppler ultrasonography. Blood lipid and gluco-lipid metabolic profiles were determined. Results IMT in APP≥60 mmHg group was significantly increased compared with that of APP＜60 mmHg group （0.19±0.06） vs （0.15±0.03）cm,P＜0.01. IMT positively correlated with APP （r=0.38,P＜0.01）. Compared with APP＜60 mmHg group,the 24 h SBP,24 h PP and 24 h PPI of APP≥60 mmHg group were significantly increased 24 h SBP （138.1±11.8） vs （119.0±10.2）mmHg,P＜0.01; 24 h PP （72.8±8.9） vs （54.9±6.2）mmHg,P＜0.01; 24 h PPI（0.52±0.09） vs （0.45±0.08）,P＜0.05. The 24 h DBP,blood lipid and other gluco-lipid metabolic indexes had no significant difference（P＞0.05）between the two groups. After adjustment for serum glucose,lipid profiles and 24 h SBP,DBP,no association between APP and IMT in carotid artery was found. Conclusion Higher APP was associated with thicker of carotid intima media in the very old patients with EH. The higher the APP,the worse the carotid artery subclinical atherosclerosis.