OBJECTIVE: With the aging population of China, a higher prevalence of peripheral arterial disease (PAD) is observed. The albumin-globulin ratio (AGR) has a certain value in predicting cardiovascular mortality, but little research has been conducted on the association between AGR and PAD. Therefore, this study aims to explore the association between AGR and PAD in hypertensive adults. METHODS: This retrospective cross-sectional study recruited a total of 28, 684 participants from March 2018 to August 2018 in Wuyuan County, Jiangxi Province, and Yuexi County, Anhui Province. A generalized additive model was utilized to analyze the relationship between AGR and PAD. RESULT: A total of 24, 808 hypertensive adults were included in this study. The regression analysis of the generalized additive model revealed an inverse association between AGR and PAD when AGR was set as a continuous variable. Further analysis with AGR divided into quartiles indicated a lower risk of peripheral artery disease in the Q2, Q3, and Q4 groups compared with the Q1 group. Specifically, in the fully adjusted model (Model 3), the risk of peripheral artery disease in the Q2, Q3, and Q4 groups decreased by 11% (OR: 0.89; 95%CI: 0.71-1.10; P = 0.278), 27% (OR: 0.73; 95%CI: 0.58-0.92; P = 0.008), and 35% (OR: 0.65; 95%CI: 0.51-0.84; P < 0.001) compared with the Q1 group, respectively. Subgroup analysis found that the relationship between AGR and PAD was more significant in the smoking and stroke populations. CONCLUSION: A negative association was observed between AGR and PAD, with this relationship being particularly pronounced in individuals who smoke or have a history of stroke.