Objective: To investigate the relationship between serum homocysteine (Hcy) level and renal function and carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM) complicated with hypertension. Methods: The clinical data of 168 patients with T2DM who were admitted to Anhui Second People's Hospital from July 2018 to May 2021 were retrospectively analyzed. According to whether they were complicated with hypertension or not, they were divided into T2DM complicated with hypertension group (combined group) 87 cases and simple T2DM group (T2DM group) 81 cases, another 87 healthy subjects were selected as the control group during the same period. The serum Hcy level and renal function indexes [serum creatinine(Scr), urine creatinine(CR), urine microalbumin/creatinine(ACR), urine immunoglobulin G/creatinine (IGU/CR), urine transferrin/creatinine (TRU/CR), urine α1-microglobulin/creatinine(α1/CR), Glomerular filtration rate (eGFR)] and left and right carotid intima-media thickness (IMT), Crouse integral of each group were compared. The correlation between Hcy level and renal function indexes, IMT, Crouse integral were analyzed by Pearson correlation analysis. Results: The level of the serum Hcy, Scr, CR, ACR, IGU/CR, TRU/CR, α1/CR and left IMT, right IMT, Crouse integral in the combined group and T2DM group were higher than those in the control group, and those in the combined group were higher than those in T2DM group (P<0.05). The level of eGFR in the combined group and T2DM group was lower than that in the control group, and that in the combined group was lower than that in the T2DM group (P<0.05). Pearson correlation analysis showed that the serum Hcy level was positively correlated with Scr, CR, ACR, IGU/CR, TRU/CR, α1/CR, left IMT, right IMT and Crouse integral in T2DM patients with hypertension (P<0.05), and negatively correlated with eGFR level (P<0.05). Conclusion: The serum Hcy level in T2DM patients with hypertension is abnormally increased, which is related to renal function injury and carotid atherosclerosis. [ABSTRACT FROM AUTHOR]