Abstract: Objective To explore the predictive value ofmonocytetohigh density lipoproteincholesterol ratio (MHR) forcoronary artery calcification in patients with hypertension. Methods A total of 153 hypertension patientswho were admitted to Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University from July 2018 to December 2020, were enrolled. According to coronary CT angiography (CTA) results, they were divided into two groups: a coronary artery non-calcification group and a coronary artery calcification group. Their general informationand laboratory test results were collected to calculate MHR. The correlation between MHR and coronary artery calcification scores (CACS) was analyzed by Pearson method. A receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of MHR for coronary artery calcification in patients with hypertension. Results There were significant differences in age, smoking, diabetes, white blood cell count, monocyte count, high density lipoprotein cholesterol and MHR between non-calcified coronary artery group and calcified coronary artery group (P<0.05). There were statistical differences in MHR and CACS among patients with different degrees of calcification (P<0.05). MHR increased as calcification aggravated (P<0.05). MHR was positively related to CACS in hypertensive patients (r=0.475, P<0.01). According to ROC curve analysis, the area under curve (AUC) of MHR for predicting coronary artery calcification was 0.684 (95%CI: 0.600-0.767, P<0.01). The sensitivity and specificity of MHR were 0.671 and 0.592, respectively, when the optimal cutoff value was 0.310. The AUC of MHR for predicting severe calcification of the coronary artery was 0.828 (95%CI: 0.741-0.915, P<0.01), and the sensitivity and specificity were 0.852 and 0.673, respectively, when the optimal cutoff value was 0.361. Conclusions MHR increases with the aggravation of coronary artery calcification in patients with hypertension, which has certain predictive value for coronary artery calcification in patients with hypertension.