Backgrounds Retinol binding protein 4 (RBP4) is a recently discovered adipocytokine that is reported to correlate significantly with insulin resistance (IR) and components of the metabolic syndrome (MetS). Also, high molecular weight (HMW) adiponectin has been reported to be more highly correlated with IR and metabolic risk factors compared to adiponectin. But, the correlation between these adipocytokines and IR or metabolic risk factors in hypertensive patients were remained unclear. We sought to determine the association of RBP4 and HMW adiponectin with the indices of IR and metabolic risk factors and compared with that of adiponectin in hypertensive patients. Methods The study was performed on 308 (148 males, age 57.3 짹 9.6 yrs) treated hypertensive patients (189 non-MetS and 119 MetS). Frozen plasma of the study population were used for analysis of RBP4 (ELISA, Immunodiagnostik, Bensheim Germany), adiponectin (RIA, LINCO, Missouri, USA) and HMW adiponectin (ELISA, LINCO, Missouri, USA). Results There was no significant difference in RBP4 level in patients with MetS compared to non-MetS although adiponectin and HMW adiponectin levels were significantly lower in patients with MetS. Correlation analysis of log transformed RBP4 with IR and metabolic parameters revealed that there was no significant correlation of RBP4 with waist circumference (r = 0.047, p = 0.375), HDL cholesterol (r = 0.001, p = 0.984), ApoB/ApoAI ratio (r = 0.068, p = 0.234) and the HOMA index (r = 0.017, p = 0.756). However, correlation analysis for adiponectin and HMW adiponectin revealed significant correlation with IR and metabolic parameters. With IR defined as HOMA index of more than 2.5, the predictive value for IR was slightly better for HMW adiponectin compared to adiponectin (AUC = 0.679 vs 0.647, p = 0.083). The predictive value of IR by RBP4 was minimal (AUC = 0.538). Conclusion RBP4 was not associated with IR or metabolic indices in this population of hypertensive subjects. HMW adiponectin demonstrated a slightly better predictive value of IR compared to adiponectin. However, the correlation with metabolic indices was similar.