Abstract: Objective To investigate the relationship of red cell distribution width（RDW） with plasma renin activity, brachial-ankle pulse wave velocity（baPWV） and carotid plaque in patients with essential hypertension（EH）. Methods From January 2016 to November 2019 a total of 531 EH patients in Henan Province People’s Hospital were enrolled. The patients were divided into four groups according to RDW quartile levels. The plasma renin activity, baPWV and carotid plaque were compared among four groups. Results The renin activities in the groups from first to fourth RDW quartile were 0.6（0.3-1.6）, 0.9（0.4-2.2）, 1.4（0.3-2.7）, and 1.8（0.4-4.3） μg/（L·h）; the baPWVs on the left side were 1 476（1 334-1 682）, 1 498（1 354-1 703）, 1 568（1 436-1 754）, 1 612（1 447-1 834） cm/s, baPWVs on the right side were 1 514（1 337-1 694）, 1 504（1 367-1 727）, 1 576（1 444-1 802）, 1 612（1 450-1 843） cm/s; and the incidences of carotid plaque were 32.6%, 43.8%, 48.5% and 54.0%, respectively. There were significant differences in the levels of above measurements among the four groups（all P＜0.01）. Correlation analysis showed that RDW was positively correlated with renin activity and baPWV（right and left side）, correlation coefficients were 0.229, 0.224 and 0.243（all P＜0.01）. RDW in carotid plaque group were significantly higher than those in non-plaque group（P=0.001）. After adjusted for 24 h systolic blood pressure, partial correlation analysis showed that carotid plaque, standing renin activity, right baPWV and left baPWV were positively correlated with RDW with correlation coefficients of 0.095, 0.194, 0.158 and 0.152（all P＜0.01）. Conclusion RDW is positively correlated with standing renin activity, baPWV and the incidence of carotid plaque in patients with EH.