Objective To investigate the relationship between pericoronary fat attenuation index(pFAI)and left ventricular hypertrophy(LVH)in patients with essential hypertension.Methods Sixty-one patients with essential hypertension hospitalized in the the First Affiliated Hospital of Anhui Medical University from December 2021 to Decem-ber 2022 were included in this study.According to the left ventricular mass index(LVMI)by the color Doppler echocar-diography results,the patients were divided into hypertension without LVH group(non-LVH group,n=34)and with LVH group(LVH group,n=27).The medical records and coronary computed tomography angiography(CCTA)ima-ging data were reviewed.And the general clinical information,laboratory results,electrocardiogram,echocardiography and CCTA data were collected and analyzed.Results Compared with the non-LVH group,patients in the LVH group showed an increase in LAD-FAI[(-83.70±7.31)Hu vs(-88.29±7.00)HU,t=-2.483,P=0.016]and RCA-FAI[(-82.78±10.41)HU vs(-88.91±7.50)HU,t=-2.577,P=0.013],with an ascending trend in LCX-FAI[(-82.15±6.48)HU vs(-85.26±8.05)HU,t=-1.632,P=0.108].There was positive correlation between pF AI with LVMI,specifically,LCX-FAI(r=0.435,P<0.001),RCA-FAI(r=0.339,P=0.011),and LAD-FAI(r=0.259,P=0.057).Conclusion pFAI is positively correlated with LVH in patients with essential hypertension.