Background Vascular structural(intima-media thickness, IMT) and functional(carotid stiffness, cPWV)alterations are related to different pattern of left ventricular (LV) geometry in general populations and in hypertensives. The relationship between vascular damage and LV geometry has not been analyzed prospectively in patients undergoing coronary angiography. Methods 399 consecutive patients with clinical indication to coronary angiography, prospectively underwent standard ultrasound examination for the evaluation of LV mass index(LVMi g/m2.7), relative wall thickness(RWT), distal anterior descending coronary artery flow velocity(LADd_vel), carotid ultrasound with real time echotracking system for measurement of central blood pressure(cSBP, cDBP), common carotid intima media thickness(cIMT) and carotid pulse wave velocity(cPWV) (Esaote MyLab 70). The noninvasive evaluations were performed blindly to clinical information, before coronary angiography. Results cIMTand cPWVwere higher in patients with concentric LVH(LVMI>49 g/h2.7 in men and ≥47 g/h2.7 in women and RWT≥ 0.42) as compared to N (normal LV mass and geometry) and CR (concentric remodeling, normal LVMi and RWT>0.42). LADd_vel was greater in patients with concentric LVH than in others groups. The prevalence of coronary stenosis(>50%) was greater in patients with concentric LVH and CR as compared to N. Patients with concentric geometry (RWT≥0.42) showed higher values of cIMT(773±169 vs 729±162, p<0.005), cPWV(8.9±2.7 vs 9.6±2.6, p<0.05) and LADd_vel(40±22 vs 48±31, p<0.05) and a greater prevalence of coronary stenosis(>50%)than patients with RWT<0.42(53 vs 69%, p<0.005). Conclusions Our results confirm that in patients undergoing coronary angiography concentric geometry in associated with structural and functional carotid alterations, with increased central blood pressure and anterior descending coronary artery flow velocity. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography.