Objective To investigate the correlation between serum neuregulin-1 (NRG-1) and ventricular remodeling in patients with essential hypertension and heart failure.Methods A total of 216 patients with essential hypertension complicating heart failure and 131 essential hypertension patients without heart failure in our hospital from January 2019 to December 2020 were enrolled as observation group and control group, respectively. The general conditions, laboratory indexes, cardiac parameters, and left ventricular remodelling index were compared between groups. Multivariate Logistic regression analysis was used to screen the risk factors of heart failure in essential hypertension patients. The observation group was further divided into subgroups according to New York Heart Association (NYHA) classification, including grade Ⅱ group (n = 81), grade Ⅲ group (n = 106), and grade Ⅳ group (n = 29). The left ventricular remodeling index and serum NRG-1 levels were compared among the three subgroups. Pearson method was applied to analyze the correlation between serum NRG-1 level and cardiac parameters, left ventricular remodeling index and the severity of heart failure.Results The course of hypertension, the levels of fasting blood glucose, total cholesterol, triglyceride, N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase-MB (CK-MB), C-reactive protein (CRP), and NRG-1, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), left ventricular ejection fraction (LVEF), and left ventricular remodeling index showed significant differences between observation group and control group (P < 0.05). Multivariate Logistic regression analysis showed that long-term course of hypertension [O^R = 3.037 (95% CI: 1.874, 6.593)], elevated levels of fasting blood glucose [O^R = 2.316 (95% CI: 1.405, 4.226)], total cholesterol [O^R= 2.142 (95% CI: 1.310, 3.475)], triglyceride [O^R = 3.593 (95% CI: 2.017, 8.450)], and NRG-1 [O^R = 2.244 (95% CI: 1.113, 3.792)], and low left ventricular remodeling index [O^R = 3.593 (95% CI: 1.859, 8.905)] were contributing factors for the development of heart failure in patients with essential hypertension (P < 0.05). Among three subgroups, serum NRG-1 level was the lowest in grade Ⅱ group, followed by grade Ⅲ group, and was the highest in grade Ⅳ group (P < 0.05). Meanwhile, the left ventricular remodeling index was the highest in grade Ⅱ group, followed by grade Ⅲ group, and was the lowest in grade Ⅳ group (P < 0.05). Serum NRG-1 levels in essential hypertension patients with heart failure were positively correlated with LVEDD, LVESD and the severity of heart failure (r = 0.605, 0.738 and 0.634, all P < 0.05), and negatively correlated with LVEF and left ventricular remodeling index (r = -0.667 and -0.527, both P < 0.05).Conclusions NRG-1 level and left ventricular remodeling index are risk factors that affect the development of heart failure in patients with essential hypertension, and the serum NRG-1 level shows a negative correlation with left ventricular remodeling index in patients with essential hypertension and heart failure.