Background and Aim. Renal resistance index (RRI), assessed by Duplex-Doppler sonography, has been classically considered as a mere expression of intrarenal vascular resistance. Recent studies, however, have showed that RRI is also influenced by upstream factors, especially arterial compliance, confirming its possible role as a marker of systemic vascular alterations. Several studies have shown that carotid intima-media thickness (cIMT) and carotid plaques (cP), assessed by ultrasonography, are documented markers of subclinical organ damage as well as expression of progressive atherosclerotic disease, and that they get worse with the progressive deterioration of renal function. The study was aimed to evaluate the relationship between RRI and severity of carotid atherosclerosis in hypertensive subjects with and without impaired renal function. Methods and Results. The study population, including 263 hypertensive patients (30-70 years), was split into 3 groups based on cIMT and presence of cP (cIMT≤0.9 mm and no cP; cIMT>0.9 mm and no cP; cP). All patients were also divided into 2 subgroups (normal renal function;CKD stage I-IV). A stepwise increase in RRI corresponding to the groups of progressive severity of carotid atherosclerosis was observed (respectively 0.61±0.07, 0.65±0.06, 0.68±0.06; p<0.001). A strong positive correlation was observed between RRI and cIMT in the whole population (r=0.43;p<0.001) and in the subgroups with (r=0.42;p<0.001) and without (r=0.39;p<0.001) CKD. These associations remained statistically significant even after adjustment for various confounding factors. Conclusion. Showing a close association between RRI and severity of carotid atherosclerosis, our results strengthen the concept that RRI is a marker of systemic vascular changes.