Aim To observe the correlation between serum C1q tumor necrosis factor related protein 3 (CTRP3), total myocardial ischemia burden (TIB) and myocardial ischemia in patients with coronary heart disease (CHD) and hypertension. Methods The clinical data of CHD patients with hypertension admitted to our hospital from January 2018 to December 2018 were retrospectively analyzed. Among them, 32 patients without myocardial ischemia were included in the non-myocardial ischemia group, and 80 patients with myocardial ischemia were included in the myocardial ischemia group. The level of serum CTRP3 and TIB were compared between the two groups, and the correlation between CTRP3 and TIB was analyzed. The influencing factors of myocardial ischemia in patients with CHD and hypertension, and the predictive value of CTRP3 and TIB for myocardial ischemia in patients with CHD and hypertension were analyzed. Results Compared with non-myocardial ischemia group, CTRP3 was lower and TIB was higher in myocardial ischemia group, and the differences were statistically significant (P＜0.05). After bivariate Spearman correlation test, serum CTRP3 level was negatively correlated with TIB (r＝－0.665, P＜0.001). Linear regression analysis showed that CTRP3 and TIB might be the influencing factors of myocardial ischemia in patients with CHD and hypertension (P＜0.05). ROC curve analysis showed that the area under curve of CTRP3 and TIB in predicting myocardial ischemia in patients with CHD and hypertension was 0.942 and 0.913 respectively, which had higher predictive value. ConclusionSerum CTRP3 and TIB are closely related to myocardial ischemia in CHD patients with hypertension, which have high predictive value for myocardial ischemia in CHD patients with hypertension.