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Introduction: The association between hyperuricemia and cardiovascular disease in hypertensive subjects is controversial. Attempts to elucidate the possible association between hyperuricemia and early atherosclerosis in hypertensive patients may provide alternative prevention or therapy targets for future cardiovascular events. Methods: A total of 67 hypertensive and 30 healthy subjects underwent B-mode ultrasonography to measure carotid intima media thickness (C-IMT). All biochemical analyses were assessed by local laboratories using standard laboratory methods. Results: C-IMT, serum uric acid (UA) levels, and mean arterial blood pressure (MBP) levels were significantly higher in hypertensive population compared to healthy subjects ( P<0.001). Among hypertensive subjects, high sensitivity C-reactive protein (hs-CRP), C-IMT, and proteinuria levels were significantly higher in hyperuricemic patients compared to normouricemic participants (for all, P<0.05). Age ( r=0.28, P=0.02), MBP ( r=0.34, P=0.04), hs-CRP ( r=0.58, P=0.006), proteinuria ( r=0.58, P=0.007), estimated glomerular filtration rate ( r=−0.35, P=0.02), and UA ( r=0.31, P=0.02) levels were significantly associated with C-IMT levels. Multiple linear regression analysis using C-IMT as a dependent variable showed that age ( beta=0.84, P=0.03) and UA levels ( beta=−0.87, P=0.02) were independently associated with C-IMT. Conclusion: Hyperuricemia is an independent predictor for early atherosclerosis in hypertensive subjects with normal renal function. Therefore, the optimal control of UA may provide further benefits in preventing atherosclerosis and hypertensive end-organ injury. [ABSTRACT FROM AUTHOR]