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Background Vascular injury is a landmark of hypertension and exteal counterpulsation (ECP) has been identified as a non-invasive treatment to restore the capacity of endothelial cells.However,the effect of ECP on blood pressure lowering in hypertension and the potential mechanism remain unknown.Methods We measured the ambulatory blood pressure(AMBP) and flow-mediated endothelial dilation (FMD) in the essential hypertensive patients who were randomly assigned to ECP group (n =20) or control group (n =20).We also evaluated in vitro migration and adhesion function of endothelial progenitor cells (EPCs).Furthermore,multivariate analysis was performed to determine the actual correlation between EPC function and FMD.Results Compared with the control,ECP group exhibited decreased systolic [(133.2 ± 4.9) mmHg vs.(139.3 ± 6.4) mmHg,P ＜0.05] and diastolic [(83.4 ± 4.5) mmHg vs.(89.5 ± 7.6) mmHg,P ＜ 0.05] blood pressure and increased FMD value[(8.87 ± 2.46) ％ vs.(7.51 ± 2.32)％,P ＜ 0.01].In addition,the migration [(47.3 ± 6.4)/hpf vs.(33.4 ± 5.1) hpf,P ＜ 0.05] and adhesion [(45.1 ± 5.5)/hpf vs.(28.4 ± 3.9) hpf,P ＜ 0.05] function of EPCs in ECP group were improved significantly,while no change was observed in the control.Both migration (OR =0.47,95％ CI:0.27-0.64,P ＜ 0.05) and adhesion (OR =0.44,95％ CI:-0.0034-0.0012,P ＜ 0.05) of EPCs correlated with FMD.After multivariate analysis,the migration (β =3.37,95％ CI:1.67-5.33,P ＜ 0.05) and adhesion (β =3.98,95％ CI:1.12-6.43,P ＜ 0.05) function still independently correlated to FMD.Conclusions The present study demonstrates for the first time that ECP decreases both systolic and diastolic blood pressure and increases FMD value in hypertension.The fall in endogenous EPCs repair capacity might be an important mechanism of hypertensive vascular injury and could be restored by ECP.