Atherosclerosis and hypertension are two important pathological vascular processes which share a crucial common pathway: an altered vascular homeostasis characterized by endothelial dysfunction. Carotid intima-media thickness (CIMT) measured by ultrasound has been shown to correlate with the presence of cardiovascular disease and is now widely accepted as a subclinical marker for atherosclerotic disease. Large body of evidences has shown that antihypertensive drugs exert important anti-atherosclerotic effects, which depend to some extent on the degree of blood pressure lowering provided by these drugs. Many randomized clinical trials of antihypertensive drugs (calcium channel blockers, angiotensin converting enzyme inhibitors, α- and β-blockers, diuretics, and angiotensin-1 receptor blockers) compared with placebo or no-treatment have demonstrated both a reduction of CIMT, a validated measure of subclinical atherosclerosis and predictor risk for clinical cardiovascular events, than a protection against clinical stroke events. However, important technical aspects of CIMT measurement must be considered. Over the last twenty years there have been great changes in the sensitivity of transducers and hence accuracy of measurement. This review explores the effectiveness of antihypertensive drugs in preventing CIMT progression and/or regression.