Objective: Whether the accessory renal arteries (ARAs) are involved in hypertension has been disputed for decades. Our study was designed to determine whether there were differences between primary hypertensive patients with or without ARAs. Design and method: Patients who has been diagnosed with essential hypertension in our hospital between June 2017 and October 2019 were collected. They were divided into two groups according to the presence or absence of ARAs confirmed by computed tomography angiography of renal arteries. Control group comprised 126 patients whose kidneys were supplied by single arteries while ARAs group comprised 118 patients with accessory renal arteries. The background and clinical data of these patients were collected. Results: There were no significant differences in age, hypertension duration, diabetes, smoking, BMI and drug history of antihypertensive treatment between the two groups (all P > 0.05). In our study, 45.8% of accessory renal arteries were on the left, 29.7% on the right and 24.5% on both sides. Male patients had a higher incidences of ARAs (72.9%).Mean blood pressure in 24 hours was 143/93 ± 15/11 mmHg in ARAs group while 151/99 ± 14/10 mmHg in control group. The blood pressure was significantly high in patients with ARAs than patients without ARAs (P < 0.01). Renin concentration was higher in ARAs group than control (P = 0.037). Target organ damage was compared. The thickness of left ventricular posterior wall and interventricular septum was dramatically increased in ARAs group compared with that of control (all P < 0.01).Left atrial dimension of ARAs group was greatly larger than control (P < 0.01). Creatinine and cystatin C was increased in ARAs group compared with that of control (P = 0.032 and 0.01 respectively). Flow-mediated dilation (FMD) was remarkably low in ARAs group compared with control (P = 0.017). Left carotid intima-media thickness (IMT), right femoral IMT and bilateral popliteal IMT of ARAs were significant thicker than control group (all P < 0.05). Conclusions: We concluded that patients with accessory renal arteries may have higher blood pressure. The mechanism involved maybe the increased renin concentration. Hypertensive patients with accessory renal artery may lead to more serious damage in target organs.