Serum salusin-alpha, is decreased in essential hypertension and acute coronary syndrome. The study is aimed to explore whether serum salusin-alpha is associated with atherosclerosis and left ventricular (LV) diastolic dysfunction in essential hypertension. Echocardiography, carotid ultrasonography, brachial-ankle pulse wave velocity (BaPWV) and serum salusin-alpha levels were determined in 60 hypertensive patients (29 with and 31 without carotid plaque) and 30 normotensive controls. Hypertensive patients with plaque, compared with those without plaque or the controls, had the lowest values of salusin-alpha. Then the hypertensive patients were divided into left ventricular hypertrophy (LVH) and non-LVH groups according to the echocardiography. Similarly, hypertensive patients with LVH showed the lowest serum salusinalpha levels. In all subjects, serum salusin-alpha levels were negatively correlated with carotid mean-intimamedia thickness (IMT), BaPWV, left ventricle mass index (LVMI) and E/E 0 (r ¼ À0.488, Po0.001; r ¼ À0.381, Po0.001; r ¼ À0.294, P ¼ 0.006; r ¼ À0.303, P ¼ 0.005; respectively). Serum salusin-alpha levels were independent predictors of BaPWV, carotid strain, carotid distensibility, mean-IMT, LVMI and E 0 /A 0 (b ¼ À0.399, 0.283, 0.237, À0.346, À0.306, 0.469; P ¼ 0.002, 0.031, 0.016, 0.005, 0.012 and 0.001, respectively) in multiple linear regression models. These results suggest that serum salusin-alpha may be associated with atherosclerosis and LV diastolic dysfunction in essential hypertension.