Abstract： Objective To investigate the correlation between homocysteine (Hcy) and cerebrovascular hemodynamic accumulative scores in primary hypertension patients. Methods A cross-sectional survey was conducted in 2 767 patients with essential hypertension who were simultaneously tested for serum Hcy and cerebral vascular function in the health management/physical examination center in Chongqing General Hospital from October 2015 to March 2018. The prevalence of hyperhomocysteinemia (HHcy) was also explored. Differences between cerebrovascular hemodynamic accumulative scores and its abnormal rate among different Hcy levels were evaluated using the analysis of variance and χ2tests, and logistic regression was used to analyze the correlation between Hcy and cerebrovascular hemodynamic accumulative scores. Results The median level of Hcy in primary hypertension was 11.8 (9.3-15.0) μmol/L. HHcy prevalence was 25.15% (27.01% in men and 19.80% in women), which was higher in men than women (χ2=14.576, P<0.001) and was increasing with age (P<0.001). The proportion of stroke, proportion of taking hypotensive medications, age, fasting plasma glucose, systolic pressure, pulse pressure, and Hcy were significantly higher in the abnormal score (<75 points) group (P<0.001) than in the normal score (≥75 points) group. The average cerebrovascular hemodynamic accumulative score was 86.99±16.10 points. The score in the highest quartile of Hcy (77.91±16.10) was significantly lower than that in other quartiles. The abnormal score rate (<75 points) was 15.25% and was increasing with the Hcy level (χ2=13.986, P<0.001). Logistic regression showed that Hcy in the second, third, and highest quartiles observed in abnormal scores was, respectively, 1.913-fold, 2.045-fold, and 7.497-fold higher than that in the lowest quartile after adjusting the confounding factors. Conclusion Hcy may be an independent risk factor for abnormal cerebrovascular hemodynamic accumulative scores in primary hypertension. Cerebrovascular dysfunction should be closely monitored when Hcy was higher than 15 μmol/L.