Objective: The Endothelial dysfunction and the arterial stiffness are the signs of cardiovascular diseases especially in the hypertensive patients with insulin resistance. The endothelial dysfunction were assessed by the brachial flow mediated dilatation. The arterial stiffness markers which are expected to be early increased in hypertensive patients with insulin resistance were assessed for detection of coronary artery disease. The aim of this study: to detect the association between arterial stiffness markers and the presence of coronary artery disease and the assessment of CAD severity by syntax II score in hypertensive patients with insulin resistance. Design and method: A total of 120 hypertensive patients who underwent coronary angiography in catheterization unit from January 2019 to October 2020 by using the (homesostatic model assessment of insulin resistance) were divided into (Group A) sixty patients with insulin resistance and CAD (Group B) sixty patients without insulin resistance and no CAD. The brachial flow mediated dilatation was measured. The Mobil O Graph blood pressure device was used to measure the PWV and Aix at rest and three min after isometric handgrip exercise at 40% of the maximal handgrip power. The inter-arm systolic blood pressure difference from both arms was calculated. The severity of the coronary artery diseases were assessed by the syntax II risk score. Results: In our study the predictive value of FMD for the detection of CAD in group A with a cutoff value >0.448 (P < 0.0001), (sensitivity of 88.9% and specificity of 91.8%). After isometric exercise handgrip for 3 min, the Aix was increased significantly in patients with CAD (before 16.7% vs. 3 min after 23.6%, P = 0.001). PWV was increased significantly in patients with CAD (before 11.5 vs. 3 min after 12.2 m/s,P = 0.001). The Inter Arm Blood Pressure Difference more than 10mmHg were associated with a high syntax II risk score compared to the patients with values less than 10 mmHg (p < 0.001). Conclusions: FMD and after isometric handgrip exercise (PWV and Aix), are independent predictors for CAD. The Inter Arm Blood Pressure Difference more than 10mmHg was associated with a higher syntax II risk score.