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Background: To date no definitive results exist about the relationship of Serum Uric Acid (SUA) and TOD in HT subjects. We sought to determine if such an association exist between SUA and subclinical cardiac, vascular and renal alterations in HT. Methods: We enrolled 632 consecutive outpatients, followed by the Hypertension Unit of S. Gerardo Hospital (Monza, Italy) affected by essential HT. We evaluated anamnestic data, clinical BP and laboratory data as well as TOD with cardiac echocardiography (both as LMVI and diastolic function – E/A), carotid ultrasound (IMT), arterial stiffness (PWV) and renal function analysis (creatinine and microalbumiuria). Results: Age was 53.4±12.7 years, SBP/DBP were 140.5±18.8 and 85.1±13.1 mmHg and SUA was 5.2±1.4 mg/dL. Regarding TOD mean LVMI was 109.6±31.4g/m2, IMT 0.71±0.1 mm, PWV 8.5±2.2 m/s, while creatinine and microalbuminuria were 0.8±0.2 mg/dL and 25.4±126.1 mg/24h respectively. When subjects were divided into high and low SUA group (depending on the median SUA of 5.2 mg/dL), with similar age and BP values the first group showed significantly higher values of metabolic index (BMI, HDL chol, triglycerides and glucose, p < 0.001), LVMI (117.1±32.8 vs 102.1±28.1g/m2, p < 0.01), IMT (0.73±0.1 vs 0.70±0.1mm, p = 0.04), PWV (8.8±2.4 vs 8.3±2.1m/s, p = 0.01) and creatinine (0.9±0.2 vs 0.7±0.1 mg/dL, p < 0.01) and lower E/A (1,0±0.3 vs 1.1±0.3, p < 0.01). SUA showed significant correlation with sex, age, BMI, SBP, HDL chol, triglicerides, glucose, creatinine, IMT, LVMI and E/A. Regarding TOD only creatinine presents SUA as as significant determinant in logistic regression analysis. Conclusion: In HT, SUA values correlate with metabolic derangements and with cardiac, vascular and renal TOD. The most significant correlation is with renal damage.