Aim To investigate the correlation between serum cystathionine-β-synthase(CBS), hydrogen sulfide (H₂S) levels and carotid intima-media thickness (CIMT) in patients with hypertension. Methods Between October 2017 and March 2018, a total of 116 patients with essential hypertension were enrolled from in-patient department of our hospital. The blood pressure, homocysteine (Hcy), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLC) and low density lipoprotein cholesterol (LDLC) were measured in all selected hypertensive patients.At the same time, the levels of CIMT, CBS and H₂S were detected. According to the levels of Hcy, the patients with hypertension were divided into two groups:H hypertension group (Hcy≥10 μmol/L) and non H hypertension group (Hcy<10 μmol/L), and the differences of Hcy, blood lipids, CBS, H₂S and CIMT were compared. The correlation between the indexes and CIMT was analyzed by Pearson test. Results The CIMT of H hypertension group was higher than that of non H hypertension group (P<0.05), and the levels of H₂S and CBS in H hypertension group were lower than that in non H hypertension group (P<0.05). Correlation analysis showed that Hcy was positively correlated with CIMT in hypertensive patients (r=0.752, P<0.05). CBS and H₂S were negatively correlated with Hcy (r =－0.413, －0.698, P<0.05) and with CIMT (r=－0.518, －0.779, P<0.05). Conclusions Compared with non H hypertensive patients, the degree of carotid atherosclerosis is more pronounced in patients with H hypertension. In patients with hypertension, the levels of CBS and H₂S are closely related with carotid atherosclerosis, which is expected to be an early predictor of atherosclerosis in hypertensive patients.