Carotid plaque offsets sex-related differences in cardiovascular risk of young hypertensive patients

•Does the presence of carotid plaque offset cardiovascular sex differences in young hypertensive patients?•From the Campania Salute Network registry, 2419 hypertensive patients 51 years old or younger were enrolled.•Women without carotid plaque had a lower risk for major adverse cardiovascular events compared to men (HR, 0.51, 95 % CI, 0.27–0.99).•This sex difference was not present in women with carotid plaque (HR 1.3, 95 % CI, 0.6–2.9).•The presence of carotid plaque in young patients with treated hypertension offsets sex-specific cardiovascular protection in women. Women have a lower risk for cardiovascular (CV) disease compared to men. Whether this difference is influenced by the presence of hypertension-mediated organ damage is unknown. To assess whether the presence of carotid plaque (CP) impacts the sex difference in risk for CV events in treated hypertensive patients. From the Campania Salute Network Registry 2419 women and men