Aim To describe the status of carotid plaque and the relationship between lipid parameters and carotid plaque in patients with hypertension. Methods This cross-sectional survey was conducted between June 2016 and June 7,2 626 subjects with hypertension who were assessed carotid plaque by Color Doppler ultrasonography at Anzhen Hospital were enrolled in the study. Results In total of subjects, 1 215 of 2 626 subjects were examined carotid plaque. The prevalence of carotid plaque was higher in men than that in women, and increased with age (all P＜0.001). Low density lipoprotein cholesterol (LDLC), non-high density lipoprotein cholesterol (non-HDLC) levels, total cholesterol (TC) level, LDLC/HDLC and TC/HDLC were significantly higher in subjects with carotid plaque than those without carotid plaque (all P＜0.01). There was no significant difference between the two groups regarding the other two lipid parameters (triglyceride (TG) and HDLC) (all P＞0.05). Carotid plaque was correlated with LDLC, non-HDLC, TC levels and ratios of LDLC/HDLC, TC/HDLC, the odds ratio was 1.373 (95%CI:1.233～1.529), 1.310 (95%CI:1.187～1.447), 1.257 (95%CI:1.147～1.376), 1.202 (95%CI:1.096～1.319) and 1.116 (95%CI:1.039～1.199), respectively after adjustment for sex, age, duration of hypertension, blood pressure control, current smoking, current drinking, lack of leisure time activities, waist circumference, plasma glucose level and homocysteine blood level. The AUC-values for LDLC/HDLC 0.551(95%CI:0.529～0.573, P＜0.001) and TC/HDLC 0.539 (95%CI:0.517～0.561, P＝0.001) didn't show the larger area under the curve than each lipid parameter separately used, for LDLC 0.557 (95%CI:0.535-0.579, P＜0.001), non-HDLC 0.553 (95%CI:0.531～0.575, P＜0.001), and TC 0.540 (95%CI:0.518～0.562, P＜0.001). Conclusions Almost half of patients with hypertension were detected carotid plaque; LDLC and non-HDLC levels were the most specific lipoprotein associated with the presence of carotid plaque, TC/HDLC and LDLC/HDLC ratios didn't show more significant correlation than each lipid parameter separately used.