Objective: Our aim was to investigate the relation between left atrial stiffness (LASt) and thoracic aortic plaque thickness in hypertensive patients with stroke. Method: A total of 97 hypertensive patients were recruited (age: 59.2 ± 7.5 years), including 56 consecutive patients with undefined stroke and 41 age-matched hyper- tensive patients without stroke. Left atrial strain and stiffness were measured using speckle tracking echo. Thoracic aortic plaque detection and evaluation was per- formed using transesophageal echocardiography. Results: Hypertensive patients with stroke, when compared with those without stroke, had a significantly higher LASt value (P < .001). The percentage of plaque 1–4 mm thickness were comparable in both groups (23.2% vs 21.9%; P > .05). While the percentage of plaque ≥4 mm thickness was much higher in hypertensive pa- tients with stroke (71.4% vs 4.9%; P < .001). LASt was considerably increased in hypertensive group with paroxysmal atrial fibrillation (PAF) when compared to hy- pertensive group without PAF (P < .01). A significant positive correlation was found between the LASt and plaque thickness (P < .001). Multivariate analysis showed that LASt was the strongest independent predictor for ≥4 mm aortic plaque thick- ness (Hazard ratio = 6.153; P < .001). With receiver operating characteristic (ROC) curve analysis, LASt > 0.63 was the best cutoff value in predicting aortic plaque thickness ≥ 4 mm. Conclusion: Left atrial stiffness was significantly associated with aortic plaque thick- ness ≥ 4 mm, in hypertensive patients with stroke. These finding prevailed the im- portance of LASt in risk stratification of hypertension.