Aim To explore the relationship between H-type hypertension and the nature of atherosclerotic plaque by the technique of intravascular ultrasound-virtual histology(IVUS-VH)in patients with coronary heart disease. Methods 71 patients in our hospital from January 2011 to March 2014 with both hypertension and coronary heart disease were chosen which included 22 samples of stable angina, 49 samples of acute coronary syndrome(ACS）. Plasma homocysteine(Hcy)and blood lipid were tested in all patients when they were enrolled. And according to the Hcy level, the patients were separated to H-type hypertension group(Hcy≥10 μmol/L, n＝42)and non H-type hypertension group(Hcy＜10 μmol/L, n＝29）. Both groups of patients accepted coronary arteriography examination and the atherosclerotic lesions were evaluated by IVUS to analyze the nature of the plaque and to identify the composition of components by IVUS-VH: fibrous(F）, fibro-fatty(FF）, necrotic core(NC)and calcium(CC）. At the last, the relationship between H-type hypertension and the plaque’s character was analyzed. Results Compared to the non H-type hypertension group, there were higher proportions of soft plaques(76.2% vs 61.7%, P<0.05）, plaque rupture(40.5% vs 13.8%, P<0.05）, sandwich and thrombosis(30.9% vs 13.8%, P<0.05)in H-type hypertension group. Analyzed by IVUS-VH, there were higher proportions of NC(23.71%±5.83% vs 15.37%±2.75%, P＝0.000)and lower proportions of CC(9.72%±4.22% vs 17.25%±0.26%, P＝0.000)in H-type hypertension group than non H-type hypertension group. Conclusion H-type hypertension is associated with the nature of atherosclerotic plaque, and it increases the vulnerability of atherosclerotic plaque in coronary artery.