Aim To study the relations of serum γ-glutamyl transferase (γ-GT) level with coronary artery calcification and stenosis in patients with hypertension. Methods 145 patients with hypertension from January 2015 to June 2018 were selected as hypertension group, and 60 cases with normal blood pressure at the same period were set as normotensive group. The serum γ-GT level was compared between the two groups. According to the results of spiral CT coronary angiography and coronary artery calcification score (CACS), patients in hypertension group were divided into mild calcification group, moderate calcification group and severe calcification group; according to the degree of coronary stenosis, patients were divided into severe stenosis group, moderate stenosis group and mild stenosis group. The levels of serum γ-GT were compared in each group. Results The level of serum γ-GT in hypertension group was significantly higher than that in normotensive group (P＜0.05); with the increase of hypertension grade, the level of serum γ-GT increased (P＜0.05). The level of serum γ-GT and CACS score in patients with different degrees of calcification were significantly different (P＜0.05); with the aggravation of calcification, the level of γ-GT increased (P＜0.05). There were significant differences in the level of serum γ-GT and the degree of stenosis in patients with different degrees of coronary artery stenosis (P＜0.05); with the aggravation of the degree of coronary artery stenosis, the level of γ-GT increased (P＜0.05). The level of serum γ-GT was positively correlated with the score of CACS and the degree of coronary artery stenosis (P＜0.05). Serum γ-GT was an independent risk factor for coronary artery stenosis or calcification in patients with hypertension. Conclusion The level of serum γ-GT is significantly increased in patients with hypertension, and and it is significantly related to the degree of coronary artery calcification and stenosis.