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Home-based blood pressure (BP) telemonitoring is a promising tool to help patients achieve optimal BP control. However, few researches evaluated target-organ damage of home-based BP monitoring. Therefore, we evaluate the relationship between home-based BP telemonitoring and urinary albumin-to-creatinineratio (ACR) in rural community hypertensive residents by using a dose-response manner.A cross-sectional study was conducted between October 2015 and April 2016 in Liaobu community, Dongguan, China. Face-to-face questionnaire investigation, physical examination, and regular laboratory examination were conducted to collect information. Each participant measured their BP continuously by using a semi-automatic sphygmomanometer twice a day for at least a month. Participants were defined as hypertension based on the thresholds of 135/85 mmHg. Microalbuminuria was defined as a ACR of at least 3.5 mg/mmol. Univariate and multivariate logistic regression were performed to access the dose-response relationship.Overall, 452 hypertensive patients were included in the study. The home systolic blood pressure (SBP) and home diastolic blood pressure (DBP) were 127.86 ± 11.14 and 80.67 ± 5.27 mmHg, respectively. After adjustment, the odds ratios and 95% confidence intervals between the percentage of increased blood pressure and the increased ACR group were as followed: home SBP, 1.20 (1.10–1.31); home DBP, 1.11 (1.03–1.18). The higher percentage of increased BP, the higher prevalence of increased ACR level was.Increased home-based BP might be a risk factor for early impaired renal function in hypertensive patients. Home-based BP telemonitoring plays an important role in managing hypertensive population.