Objective: To analyze the expression and clinical significance of lipoprotein-associated phospholipase A2 (Lipoprotein-associated phospholipase A2; Lp-PLA2) in the plasma of patients with resistant hypertension. Methods: 100 patients with refractory hypertension from April 2022 to April 2023 were selected as the study group; 100 patients with essential hypertension (blood pressure control within the normal range) were selected as the control group, Compared with patient group plasma Lp-PLA2 levels, 24h mean blood pressure [systolic BP (SBP), diastolic BP (DBP)], and hypersensitive C-reactive protein (Hypersensitive C-reactive protein; The hs-CRP) and low-density lipoprotein (low densith lipoprotein; LDL) differential expression levels and plasma Lp-PLA2 levels in different grades of hypertension, To analyze the influencing factors of resistant hypertension using Logistic regression analysis, Establish a predictive model for the corresponding factors affecting resistant hypertension, The receiver operating characteristic curve (receiver operating characteristic curve, ROC) analysis model predictive value. Results: (1) the plasma Lp-PLA2,24 hBP (24 h DBP, 24 h SBP), LDL and hs-CRP in the study group were higher than those of the control group, Statistically significant difference between groups (P <0.05); (2) The plasma Lp-PLA2 levels in patients with BP grades 1 to 3 were higher than the control group, And the higher the hypertension grade, The higher the plasma Lp-PLA2 levels in the patients, Statistically significant difference between groups (P <0.05); (3) The results of the Logistic regression analysis showed that, Lp-PLA2 level, 24 hBP, LDL, and high expression of hs-CRP were all influencing factors of resistant hypertension (P <0.05); (4) The ROC curve results show that, The best cut-off value of the prediction model was 0.0896, Area under the ROC curve (area under curve, AUC) is 0.704 (0.651~0.779), 0.737 (0.646~0.758), 0.762 (0.647~0.831), 0.762 (0.647~0.831) and 0.879 (0.785~0.993). Conclusion: The plasma level of Lp-PLA2 in patients with resistant hypertension is significantly higher than the normal value, and the severity of patients' disease is proportional to the plasma level of Lp-PLA2. Strengthening the dynamic monitoring of plasma Lp-PLA2 levels in patients with resistant hypertension is helpful to improve the clinical treatment effect.