Abstract: Objective To investigate the effect of hypertension on the prevalence of acute coronary syndrome（ACS） and the severity of coronary artery disease in young women in northern China, so as to provide reference for clinical prevention and treatment. Methods A retrospective analysis was performed on 840 young female patients（age ＜45 years old） underwent coronary angiography due to chest pain or chest discomfort between January 2007 and December 2016. The patients were divided into hypertension group（256 cases） and control group（584 cases） according to whether they had hypertension or not. The risk factors of ACS, the prevalence of ACS and coronary stents implantation in the two groups were observed. Results The prevalence of ACS was 80.9% in the hypertension group and 36.5% in the control group. There was significant difference between the two groups（P＜0.05）. In the hypertension group and the control group, the rate of patients with hyperlipidemia was 37.1% vs 14.9%, with hypercholesterolemia was 8.6% vs 3.4%, with hyperuricemia was 18.4% vs 7.2%, and with hyperhomocysteinemia was 10.9% vs 3.9%, and there were significant differences between the two groups（all P＜0.05）. In the hypertension group and control group, the rate of overweight was 63.7% vs 29.5%, family history of early coronary heart disease was 15.2% vs 5.5%, smoking was 5.5% vs 4.3%, menopause was 4.7% vs 1.7%, and type 2 diabetes was 24.2% vs 8.9%, and there were statistically significant（all P＜0.05）. Double branch lesions of coronary artery in hypertension group and control group were 14.1% and 5.7% respectively（P＜0.05）. The number（1.67±1.05） and the length （24.44±6.97）mm of stents implantation in hypertension patients with ACS were both larger than the number（1.41±0.85） and length （22.85±7.80）mm of stents implanted in the control group. The difference between the groups was statistically significant（P＜0.05）. Conclusions Hypertension is the main risk factor of ACS in young women in northern China. Young women with hypertension have more risk factors for atherosclerotic cardiovascular disease, and hypertension is independently associated with ACS.