Objective To observe the impact of pulse pressure (PP) and blood pressure (BP) circadian rhythm abnormality of aged hypertension patients on carotid atherosclerosis. Methods One hundred and fifty cases of elderly patients with essential hypertension based on 24 h ambulatory blood test results, according to the circadian blood pressure rates were divided into two groups,<10% in the non-dipper type hypertension group (72 cases),≥10%in the dipper type hypertension group (78 cases). Carotid ultrasound was performed to detect the extent, nature and classification of atherosclerotic plaques. The detection rate of carotid artery plaque in patients with hypertension was calculated based on their pulse pressure levels:≤60 mmHg (1 mmHg=0.133 kPa), 61~89 mmHg, ≥90 mmHg. Results Ultrasonography showed 61 cases of carotid artery plaques in the dipper type hypertension group, 20 cases were located bilaterally, 15 cases were in the right, 26 cases were in the left, the detection rate of plaque was 78%(61/78). Ultrasonography showed 68 cases of carotid artery plaques in the non-dipper type hypertension group, 38 cases were located bilaterally, 14 cases were in the right, 16 cases were in the left, the detection rate of plaque was 94%(68/72). The detection rate of plaque in the dipper type hypertension group was less than that in the non-dipper type hypertension group, the difference was statistically significant (χ2=8.07, P<0.01). There were 30 cases of hard plaque,13 cases of soft plaque, 8 cases of mixed plaque, and the plaques graded as 0, 1, 2, 3 were 17, 33, 13, 15 cases in dipper type hypertension group. There were 12 cases of hard plaque, 24 cases of soft plaque, 32 cases of mixed plaque, and the plques graded as 0, 1, 2, 3 were 6, 8, 25, 33 cases in non-dipper type hypertension group. The difference was statistically signiifcant (χ2=5.29, 8.75, both P < 0.01). Forty three patients with pulse pressure≤60 mmHg, the plaque detection rate was 72%(30/43);the pulse pressure of 65 cases was 61~89 mmHg, the plaque detection rate was 88%(57/65);42 cases with vein pressure ≥ 90 mmHg, the plaque detection rate was 98%(41/42). The difference was statistically signiifcant (χ2=11.65, P=0.00). Conclusion Pulse pressure increased and BP circadian rhythm abnormality are risk factors for the formation of carotid atherosclerosis.