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To investigate the influence of Astragalus in the protection of cardiovascular structure and function in essential hypertensive patients with metabolic syndrome (MetS) depending on gender.This is a prospective, open labeled, parallel randomized controlled trial. 206 hypertensive patients with MetS between 18 and 60 years were randomly assigned to control group, Astragalus group 1 (Astragalus 10 g/d) and Astragalus group 2 (Astragalus 5 g/d). Metabolic related indexes were measured by laboratory blood tests. Left ventricular end diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular diastolic posterior wall thickness (LVPWT), deceleration time (DT), early diastolic mitral annular velocity/late diastolic velocity of tricuspid annulus (E’/A’), pulmonary venous arterial reversal velocity (Ar) and mitral flow velocity (Vp) were measured by ultrasound echocardiogram. Cardio-ankle vascular index (CAVI) and ankle brachial index (ABI) were obtained by arteriosclerotic instrument. Aortic pulse wave analyzer was used to measure the carotid and femoral artery pulse wave velocity (cf-PWV) and augmentation index (AIx). All of the indicators were compared between pre-treatment and post-treatment after a 12 months follow-up. This research program is registered under the Chinese Clinical Trial Register Website (ChiCTR-TRC-11001747).Triglyceride (TG), E’/A’ and Vp were significantly improved after treatment with Astragalus in females as compared to males (P = 0.026, P = 0.031, P = 0.042 respectively). CAVI and AIx were also reduced significantly in females (P = 0.036, P = 0.017 respectively). However, other indicators showed no difference after treatment (P > 0.05). In males, most indicators had no significant difference except total cholesterol (TC) and ABI which were reduced significantly after treatment (P = 0.033, P = 0.029 respectively).The protective effect of Astragalus on cardiovascular structure and function is better in female patients than male. The sex hormones might have a role in it. A further long term study would be helpful in confirming the efficacy of Astragalus extract.