Abstract: Objective To investigate the correlation of isolated diastolic hypertension（IDH） based on different cutoff values with the carotid intima-media thickness（CIMT）. Methods A total of 23 622 patients from the Kailuan study cohort who underwent carotid ultrasound in 2010 and participated in the subsequent follow-up were observed. The subjects were divided into four groups according to the diagnostic criteria of Chinese guidelines for the prevention and treatment of hypertension（Chinese standard） or 2017 American College of Cardiology（ACC）/American Heart Association（AHA） guidelines for the management of hypertension（ACC/AHA standard）:normal blood pressure group, IDH group, isolated systolic hypertension（ISH） group and systolic-diastolic hypertension（SDH） group. Multivariate logistic regression analysis was used to analyze the influence of IDH on CIMT under different hypertension standards and in different age groups. Results There were 21 649 subjects met the inclusion criteria. According to the China standards and 2017 ACC/AHA standards, 938（4.3%） and 2 815（13.0%） subjects were diagnosed with IDH, including 202（21.5%） and 410（14.6%） patients with thickened CIMT, respectively. Taking the thickening of CIMT as the dependent variable, IDH as the independent variable, after correcting for multiple confounding factors, the multivariate logistic regression analysis showed that neither IDH diagnosed by Chinese standard nor ACC/AHA standard was associated with CIMT thickening（P＞0.05）. While in subjects under 45 years, IDH was the correlative factor for CIMT thickening（OR=1.623, 95%CI 1.005-2.622）. Conclusions The value and abnormal detection rate of CIMT are different in IDH patients diagnosed by different cutoff values. IDH is not associated with CIMT thickening. IDH should be mainly intervened in young people.