According to a United Nations report, the proportion of the global elderly population (60 years and older) is expected to rise from 10 percent today to 22 percent by 2050. Since blood pressure usually rises with age, the prevalence of hypertension is about 67% in people over 60 years of age. The prevalence of hypertension in people over 60 years of age in China is nearly 50%, and has become the most important risk factor for cardiovascular and cerebrovascular disease morbidity and mortality in the elderly population in China. Characteristics of hypertension in the elderly: systolic blood pressure rises and pulse pressure increases; with age, systolic blood pressure level rises and diastolic blood pressure level gradually decreases; blood pressure fluctuates greatly; postural hypotension and postprandial hypotension occur easily; abnormal circadian rhythm of blood pressure is common; it often coexists with a variety of diseases and has many complications. The prevalence of hypertension in elderly patients is lower, and the prevalence of refractory hypertension is even higher; the elderly are more sensitive to the adverse effects and drug interactions of antihypertensive drugs; different guidelines recommend different antihypertensive targets; complex hypertension guidelines lead to “treatment inertia”; and the combination of multiple diseases significantly reduces the quality of life. The combination of multiple diseases will significantly reduce the quality of life. These characteristics of geriatric hypertension make the elderly a special subgroup of the hypertensive population, and there is a lack of targeted clinical research to guide treatment. Elderly hypertensive patients are prone to upright hypotension, drug interactions, adverse drug reactions, often combined with other diseases, or poor compliance, making the treatment of elderly hypertension more difficult. Moreover, the elderly have reduced cerebrovascular autoregulation, and there may also be a risk of cerebral hypoperfusion with excessive blood pressure lowering. Lifestyle changes should be recommended for all patients with hypertension. Since elderly patients are more likely to develop white coat hypertension, ambulatory blood pressure monitoring can be considered to clarify the diagnosis and staging of hypertension prior to pharmacological treatment. And home self-measurement of blood pressure can also be a better predictor of cardiovascular morbidity and mortality than outpatient blood pressure. In elderly patients, a blood pressure lowering target of 150/90 mmHg can effectively reduce the risk of all-cause mortality, cardiovascular death, stroke and heart failure. Different antihypertensive drugs have similar cardioprotective effects with the same magnitude of blood pressure lowering. The reduction of systolic blood pressure in elderly hypertensive patients reduces cardiovascular risk more than diastolic blood pressure. In the selection of antihypertensive drugs, we recommend individualized treatment based on the patient’s medical history and co-morbidities. There is no evidence that a particular class of antihypertensive drug is superior to others, and diuretics, dihydropyridine CCBs, or ACEI/angiotensin receptor antagonists can be chosen as first-line agents. Since elderly patients are more sensitive to drug doses and more prone to electrolyte disturbances, antihypertensive drugs should be started in small doses and electrolytes should be monitored during use. If diuretics are combined with ACEI or ARB, or potassium-preserving diuretics, the incidence of hypokalemia can be reduced. Unless combined with old myocardial infarction, heart failure or arrhythmia, beta-blockers are not preferred.