Background: It has been reported that carotid intima-media thickness (IMT) and pulse wave velocity (PWV) is an independent predictor of cardiovascular and cerebrovascular mortality in hypertensive patients. The primary aim of this study was to elucidate the clinical significance of IMT and PWV in hypertensive patients with ischemic stroke (IS). Methods: The study group consisted of 51 hypertensive patients with IS and 61 healthy hypertensive individuals visited to Kyunghee university Neo East-West medical center from March 2007 to July 2007. IMT was measured from high-resolution, two-dimensional ultrasound machine (iE33, Philips). The Fukuda vascular profile VS-1000TM was used to determine the PWV. Results: The IMT was significantly (P = 0.012) higher in IS (0.711 짹 0.167 mm) than in control subjects (0.634 짹 0.147 mm). And, the PWV was significant (P < 0.001), too (17.68 짹 2.92 m/sec in IS vs 15.49 짹 2.55 m/sec in control). On the multivariate analysis, IMT was identified as the independent risk factors of hypertensive patients with IS. Conclusion: Increased IMT and PWV may be associated with a higher risk of IS in hypertensive patients. Therefore, IMT and PWV screening should be emphasized for hypertensive patients to prevent IS.