The present work aims to establish the frequency, determinants, and the influence of the increased carotid intima-media thickness on the assessment of cardiovascular risk in hypertensive Congolese subjects.The carotid intima-media thickness was systematically measured using B-mode ultrasound in 254 hypertensive patients aged≥25years, all native of South Kivu Province. The association between carotid intima-media thickness and various assumed risk factors was modeled in linear and logistic regressions.In the entire study population, 28% had an increased carotid intima-media thickness (≥0.9mm) and 22.4% a plaque (>1.2mm). Carotid intima-media thickness was significantly correlated only with age (partial r=0.289, P0.05).The increase in carotid intima-media thickness in hypertensive Congolese subjects would be a marker of arterial remodeling associated with a long history of uncontrolled hypertension rather than early atherosclerosis. Its systematic detection would pinpoint those at risk of stroke and optimize their treatment.