Left ventricular hypertrophy (LVH), carotid intima-media thickening (IMT) and plaques are independent predictors of cardiovascular events. Accordingly, echocardiography and carotid ultrasonography are both used for risk stratification in hypertension. However, it is not clear which marker better predicts cardiovascular events and which ultrasonographic investigation should be preferred in this setting. Objectives: To compare the prognostic value of LVH, carotid IMT and plaques in uncomplicated hypertensives. Methods: 278 patients (42% males, aged 60 ± 12 years) underwent baseline carotid and cardiac ultrasonography and were subsequently followed for 8.0 ± 3.0 years. LVH and IMT were defined as LV mass >125 g/m2 and IMT ≥0.9, respectively. Atherosclerotic burden was assessed as any plaque, plaque score (0 to 6) or stenosing (>50%) plaques. Primary end point included fatal and non fatal cardiovascular events. Hazard ratios (HRs) were estimated by Cox models. Predictive accuracy of cardiac and carotid ultrasonography was assessed using ROC curves. Results: Diabetes was present in 22% of subjects, hypercholesterolemia in 46%, smoking history in 46%. The mean 10-years cardiovascular risk was 12 ± 8%, according to Italian risk charts. LVH (HR = 2.77, CI 1.44–5.30), IMT (HR = 3.82, CI 1.86–7.82), plaque score >5 (HR = 3.82, CI 1.21–12.09) and stenosing plaques (HR = 2.69, CI 1.23–5.91), but not any plaque, individually predicted cardiovascular events. Among all markers, IMT was the strongest independent predictor (HR = 3.38, CI 1.55–7.37), superior to LVH (HR = 2.15, CI 1.08–4.26) and the other markers. Compared to Italian risk charts, carotid ultrasonography significantly increased cardiovascular events prediction (AUC = 0.74 versus 0.62, p = 0.01) and performed better than echocardiography (AUC = 0.71 versus 0.63, p = 0.04). This finding was more pronounced in the low-moderate risk subgroup (78%) (AUC = 0.75 versus 0.60, p < 0.001 and AUC = 0.72 versus 0.60, p = 0.02; carotid and cardiac ultrasonography respectively). Conclusion: IMT is the strongest predictor of cardiovascular events in uncomplicated hypertension. Carotid ultrasonography improves risk prediction better than echocardiography. Therefore, it should be firstly considered for cardiovascular risk assessment in these subjects, especially in those at apparently low-moderate risk.