Abstract: Objective To explore the relationship between 24-hour ambulatory blood pressure variability and homocysteine in patients with H-type hypertension. Methods Total 90 patients with primary H-type hypertension (homocysteine ≥ 10 μmol/L) were treated as H-type hypertension group, and 90 patients with primary simple hypertension (homocysteine<10 μmol/L) were treated as control group in Zhejiang Hospital from February, 2014 to November, 2016. Twenty-four hours ambulatory blood pressure monitoring was performed in both groups by using 24 h ambulatory blood pressure meter, and the blood pressure variability was compared between the two groups. Blood homocysteine levels were determined by enzyme cycling. Results The homocysteine level in H-type hypertensive group was higher than that in the control group (P<0.05). There were no significant difference in fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein, serum creatinine and hemoglobin level between the two groups (all P>0.05). The variability of 24 h systolic blood pressure, the variability of 24 h diastolic blood pressure, the variability of daytime systolic blood pressure, the variability of daytime diastolic blood pressure, the variability of nighttime systolic blood pressure and the variability of night diastolic blood pressure in the H-type hypertensive group were higher than those in the control group (all P<0.05). The variability of 24 h systolic blood pressure, the variability of 24 h diastolic blood pressure, the variability of daytime systolic blood pressure, the variability of daytime diastolic blood pressure, the variability of nighttime systolic blood pressure and the variability of night diastolic blood pressure were positively correlated with homocysteine in the H-type hypertensive patients (all P<0.05). Conclusion Twenty-four-hour dynamic blood pressure variability increases obviously in patients with H-type hypertension, 24 h dynamic blood pressure variability is positively correlated with homocysteine.