Objective To observe blood pressure variability (BPV) in elderly patients with primary hypertension and carotid artery intima-media thickness (IMT),and analyze the correlation between BPV and atherosclerosis.Methods One hundred and nine patients with primary hypertension were divided into non-carotid atherosclerosis group (IMT ＜ 1.0 mm,49 cases) and carotid atherosclerosis group (IMT ≥ 1.0mm,60 cases).24 h ambulatory blood pressure monitoring (ABPM) was used to measure the 24-hour mean systolic blood pressure (24 h SBP),24-hour mean diastolic pressure (24 h DBP) ; SBP of daytime (dSBP)and nighttime (nSBP) ; DBP of daytime (dDBP) and nighttime (nDBP).And their standard deviation and coetficient of variation (CV) was calculated.Results dSBP,24 h SBPCV,24 h DBPCV,dSBPCV,nSBPCV in carotid atherosclerosis group was higher than that in non-carotid atherosclerosis group [(132.3 ± 12.1)mm Hg(1 mm Hg =0.133 kPa) vs.(122.7 ± 10.8) mm Hg,0.118±0.011 vs.0.107 ± 0.023,0.142 ± 0.058vs.0.116 ±0.028,0.129 ±0.039 vs.0.105 ±0.017,0.119 ±0.060 vs.0.109 ±0.037],and there was significant difference (P ＜ 0.01 or ＜ 0.05).There was no significant difference in 24 h SBP,24 h DBP,dDBP,nSBP,nDBP,dSBPCV,nSBPCV between two groups (P ＞0.05).Conclusions BPV of carotid atherosclerosis is higher than that of non-carotid atherosclerosis.BPV and carotid artery IMT has a certain relevance.