Fassaert LMM, et al. - Prospectively gathered data of 1,684 carotid endarterectomies (CEA)-patients (2002–2014) were retrospectively investigated to study whether hypertension was related to unstable atherosclerotic plaque features in patients who underwent CEA. Elevated systolic BP was correlated with the presence of plaque calcifications, macrophages, lipid core>10% of plaque area, intraplaque hemorrhage (IPH, and microvessels. Elevated diastolic BP was related to macrophages, lipid core, and IPH though not with microvessels or plaque calcifications. Replication in an iliofemoral-cohort (n = 657) revealed that raised diastolic BP was related to the presence of macrophages, lipid core, and IPH. Thus, in severely atherosclerotic individuals, preoperative hypertension is correlated with the presence of carotid plaque macrophages, lipid core, and IPH. Moreover, the IPH, as a plaque marker for cardiovascular events, in both the CEA and iliofemoral population, is related to elevated systolic and diastolic BP.