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Background Atherosclerosis is a major health problem worldwide.Previous studies have shown that miRNAs are related to atherosclerosis.However,the relationship between miR-21 and atherosclerosis remains unknown.Therefore,this study aimed to explore the relationship between plasma miR-21 expression level and subclinical atherosclerosis in patients with hypertension.Methods We assessed the plasma level of miR-21 in 50 hypertension patients and in 30 age-and sex-matched healthy individuals.All patients underwent brachial-ankle pulse wave velocity (baPWV),office and ambulatory blood pressure monitoring.Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was used to measure miR-21.The correlations between miR-21 level and blood pressure parameters and baPWV were assessed using the Pearson correlation coefficient.Receiver operating characteristic (ROC) curve was constructed for distinguishing from atherosclerosis and healthy.Results The baseline data of all the participants such as fasting blood glucose,body mass index,serum lipid,hepatic and renal function were not significantly different between hypertension and control groups,as well as atherosclerosis and non-atherosclerosis groups (P＞0.05).The hypertensive patients showed higher plasma miR-21 (32.99±3.01 vs.26.14±1.03;P＜0.001) level as compared to controls,and in atherosclerosis group (33.53±2.86 vs.28.56±3.66;P=0.002) than that in non-atherosclerosis group.MiR-21 level was significant positively correlated with 24h mean SBP (r=0.718,P＜0.001),24 h mean DBP (r=0.247 P=0.027),office SBP (r=0.644,P＜0.001),office DBP (r=0.316,P=0.004) and baPWV (r=0.714,P＜0.001),respectively.The miR-21 for distinguishing atherosclerosis from healthy yielded an area under the ROC curve of 0.844 (95％CI:0.758,0.930;P＜0.001).Conclusion Our data provide significant evidence that circulating miR-21 may represent potential non-invasive marker of athero sclerosis in essential hypertensive patients.