OBJECTIVE: To investigate the association between the arterial velocity pulse index-to-left ventricular global longitudinal strain ratio (AVI/LVGLS) and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessed using the China-PAR model in patients with hypertension. METHODS: A total of 190 patients with hypertension and 203 controls were included. Ventricular-arterial coupling (VAC) was assessed using the AVI/LVGLS ratio, with absolute LVGLS values used to ensure consistent directional interpretation. High estimated ASCVD risk was defined as ≥10%. Least absolute shrinkage and selection operator (LASSO) regression was used to identify potential predictors of elevated ASCVD risk. Multivariable logistic regression analyses were subsequently performed to evaluate the independent association between AVI/LVGLS and ASCVD risk using both continuous and categorical (lowest fifth percentile) approaches. RESULTS: AVI/LVGLS was significantly higher in patients with hypertension than in controls (p < 0.05). LASSO regression identified AVI/LVGLS as an important predictor of high estimated ASCVD risk. Receiver operating characteristic analysis demonstrated that AVI/LVGLS had superior discriminatory performance compared with VVI, AVI, and LVGLS alone. In multivariable logistic regression analysis, AVI/LVGLS below the fifth percentile was independently associated with high estimated ASCVD risk after adjustment for conventional cardiovascular risk factors (OR = 6.106, 95% CI: 1.352-27.565, p = 0.019). CONCLUSION: VAC, assessed by AVI/LVGLS ratio, was independently associated with increased estimated ASCVD risk in patients with hypertension. AVI/LVGLS may reflect integrated myocardial and vascular alterations and could serve as a complementary marker for cardiovascular risk stratification in this population.