We analyzed in NYHA I hypertensives the interactions between Carotid Intima-Media Thickness (IMT), Hypertension and Cardiovascular (CV) risk factors and relationships between IMT, CV risk factors and left ventricular (LV) geometric remodelling. 198 asymptomatic, never treated, essential hypertensives (age: 58.2 +/- 13) and 67 (age-gender matched) healthy subjects, were studied. Complete clinical examination, 2D Doppler echocardiography and vascular echography were performed in all study subjects. Major values of IMT are present in concentric LVH. Distribution of IMT among risk factors groups shows an higher IMT respect to increasing number of risk factors (P < 0.001). Significant correlation are present between pulse pressure and IMT (P < 0.006; r = 0.19) and IMT and LVM (P < 0.0001; r = 0.35). Altered patterns of LV geometry and carotid structural changes occur in many patients with essential hypertension. LVH or carotid remodeling are greater in elderly, in patients with higher systolic BP and with associated CV risk factors.