Objective To investigate and analyze the risk factors and MRI features of patients with hypertension complicated with leukoaraiosis (LA). Methods 42 patients with hypertension and leukoaraiosis diagnosed in the hospital from February 2017 to February 2018 were selected as the observation group, and MRI features were analyzed. Fortytwo patients with hypertension and without LA were selected as the control group at the same time. Univariate and multivariate analyses were performed to analyze the risk factors for LA such as age, smoking, carbon monoxide poisoning and chronic alcoholism. Results MRI images showed T1 or T2 long signals at LA lesions. T2 weighted images could show the site of lesions, but the clarity and sharpness of lesion boundaries were poor. T2FLAIR sequence showed high signals. Logistic multivariate regression analysis showed that independent risk factors for hypertension with LA were age > 60 years, history of ischemic cerebral infarction, smoking history and history of alcoholism. Conclusion Age, history of ischemic cerebral infarction, smoking history and history of alcoholism are risk factors for hypertension with LA. MRI can effectively show the changes of lesions in patients with hypertension and LA. The combination of the two is of certain positive significance in the diagnosis and treatment of the disease.