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It has been found that serum total bilirubin has a vital role in anti-inflammatory and antioxidant progress. Prehypertension, the intermediate stage between normal blood pressure and hypertension, is linked with subclinical atherosclerosis and target-organ damage.This study was designed to evaluate the relationship between total bilirubin and carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis, in patients with prehypertension.We consecutively enrolled 219 patients with prehypertension. All the participants were divided into two groups according to cIMT values (<0.9 vs. ≥0.9 mm). We found that the increased cIMT group has higher systolic blood pressure, triglyceride and C- reactive protein, but lower total bilirubin compared to the normal cIMT group. The cIMT was negatively correlated with total bilirubin. Multivariate regression analyses revealed total bilirubin was an independent factor for subclinical atherosclerosis.This study demonstrated that serum total bilirubin was inversely related with cIMT, and was an independent predictor of subclinical atherosclerosis in patients with prehypertension.