Abstract: Objective To characterize the changes of postprandial hypotension（PPH）in patient with essential hypertension（EH）,and to investigate the relationship between PPH and carotid artery atherosclerosis. Methods One hundred and eighteen hospitalized EH patients with well-documented information were recruited. Blood pressure（BP）was measured at 5min before three daily meals and every 15 min interval within 2hafter meals. According to the changes of systolic blood pressure（SBP）after meals,all subjects were divided into two groups:PPH group（n=83）and non-postprandial hypotension group（NPPH,n=35）. The high frequency ultrasonography was performed to detect the intima-media thickness（IMT）and plaque characteristics in carotid artery. The carotid artery plaque Crouse score and rating scale were calculated. The changes of PPH in EH patients and the relationship between PPH and carotid artery atherosclerosis were analyzed. Results Overall incidence of PPH in all the hospitalized patients was 70.3%,which was higher at breakfast（50.1%）than at lunch（35.6%）and supper（27.8%）（all P＜0.0167）. Moreover,the decreases in SBP and diastolic blood pressure（DBP）after breakfast were more obvious than that after lunch and after dinner（P＜0.05）. As compared to NPPH group,the detection rate of plaque（69.7% vs 37.5%）,number of plaque1（0-3）vs 0（0-1）,Crouse score of plaque2.1（0-5.2）vs 0（0-1.9）and rating scale of carotid artery atherosclerosis2（1-2）vs 0.5（0-2）in PPH group were significantly increased（all P＜0.05）. The plagues in PPH group were mainly hard plague（59.8%）,while in NPPH group which were mainly soft plaques（46.2%）and mixed plaques（38.4%）（P＜0.05）.The detection rate of PPH（81.5% vs 53.5%）and the drop amplitude of postprandial blood pressure（23.1±2.3）vs（17.4±2.7）mm Hgin patients with carotid atherosclerotic plaque were significantly higher than that without carotid atherosclerotic plaque. Logistic regression analysis indicated that the SBP before breakfast（OR=2.30,95% CI1.32-3.99）,age（OR=2.21,95% CI1.02-4.78）and the rating scale of carotid artery atherosclerosis（OR=2.69,95% CI1.52-4.76）were independent influence factors of PPH in EH patients. Conclusion PPH is common in hospitalized EH patients,and the most frequent PPH occurs after breakfast. Moreover,EH complicated with PPH is related to the severity of atherosclerosis and characteristics of plaques in carotid artery.