Abstract: Objective To investigate the effect of plasma homocysteine (Hcy) level on coronary atherosclerosis and left ventricular function in hypertensive female patients. Methods Total 131 cases of female patients with hypertension and coronary angiography were selected. According to the plasma Hcy levels, they were assigned into H-type hypertensive group (89 cases, Hcy ≥ 10 μmol/L) and non-H-type hypertension group (42 cases, Hcy<10 μmol/L). The general basic data of patients, clinical blood biochemistry, cardiac color ultrasound and coronary angiography between the two groups were compared and analyzed. Results The prevalence of three vascular lesions and severe stenosis lesions in the H-type hypertensive group was significantly higher than that in non-H-type hypertension group; but of single branch lesion and normal coronary artery or mild coronary stenosis in the H-type hypertension group was lower than that of non-H-type hypertension Group. The Gensini score in H-type hypertension group was higher than that in non-H-type hypertension group (P<0.05). When compared with the non-H-type hypertension group, LVMI and RWT index in the H- type hypertension group were higher, but LVEF was lower, with statistical difference (P<0.05); The peak E is H-type hypertension group was higher, but LVRT was lower, the difference between the two groups was statistical significant (P<0.05). Conclusion The severity of coronary artery disease and the degree of left ventricular dysfunction in patients with H-type hypertension were worse than non-H-type hypertension patients. Plasma Hcy levels may be a risk factor for coronary atherosclerosis and left ventricular dysfunction in women with hypertension.