Abstract: OBJECTIVE To explore the influence of Helicobacter pylori (Hp) infection on activation of peripheral blood inflammatory signaling pathways nuclear factor κB/NOD-like receptor thermal protein domain-related protein 3/Caspase-1 (NF-κB/NLRP3/Caspase-1) in the elderly patients with hypertension and observe its association with vulnerability of carotid atherosclerosis plaques. METHODS A total of 585 elderly patients with hypertension who were complicated with carotid atherosclerosis plaques and treated in the First Affiliated Hospital of Guangxi Medical University from Jan. 2022 to Jun. 2025 were recruited as the research subjects and were divided into the Hp-positive group with 285 cases and the Hp-negative group with 300 cases according to the result of ¹⁴C-urea breast test. The peripheral blood lipid profiles, high-sensitivity C-reactive protein (hs-CRP), inflammatory factors , NF-κB/NLRP3/Caspase-1 and carotid artery-related indicators were detected. Univariate analysis and multivariate analysis were performed for the risk factors for the vulnerability of plaques. RESULTS The patients of the Hp-positive group showed the abnormal blood lipid profiles rise of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), decline of high density lipoprotein cholesterol (HDL-C), rise of inflammatory markers, exacerbation of carotid artery atherosclerosis (increase of IMT, plaque score and detection rate of vulnerable plaques), and activation of NF-κB/NLRP3 pathways (rise of mRNA/protein expression level); there were significant differences(P＜0.05). Multivariate analysis showed that H. pylori infection (OR=2.850), LDL-C(OR=1.920)and NLRP3(OR=2.850)expression levels were the risk factors for the vulnerable plaques(P＜0.05). CONCLUSION The H. pylori infection may activate the NF-κB/NLRP3/Caspase-1 inflammatory signaling pathways on transcriptional and translational levels, exacerbates the systemic inflammatory response and lipid metabolism disorders of bodies, and accelerate the formation of carotid atherosclerosis plaques of the elderly patients with hypertension and increase the instability.