Due to the special nature of physiological changes in the elderly, blood pressure changes also have their own characteristics, for example, high systolic blood pressure, large pulse pressure difference, abnormal circadian rhythm, large fluctuations in blood pressure, prone to hypotension, blood pressure is not easy to control, combined with a variety of diseases and other characteristics. As to what level of blood pressure should be controlled in the elderly, the current consensus is that the blood pressure of elderly people over 65 years of age should be controlled below 150/90 mmHg, and that the blood pressure of elderly people between 65 and 80 years of age can be controlled at about 140/90 mmHg if there is no dizziness and weakness and if the quality of life is not affected. 150/90mmHg is sufficient. Although the goal has been clear, but the specific implementation, a lot of difficulties, in recent years in the process of lowering blood pressure and found that some of the unique phenomenon of hypertension in the elderly, worthy of attention, is analyzed as follows. 1, upright hypotension: refers to the sitting position, squatting, lying position to the upright position within 3 minutes after the switch to a significant drop in blood pressure, such as systolic blood pressure drop of more than 20mmHg, diastolic blood pressure drop of more than 10mmHg, sometimes can not feel, sometimes can appear dizziness, blackness in front of the eyes, blurred vision, unstable standing, weakness, pale, cold sweat, fall and other symptoms; duration is generally in 5- 10 minutes, sometimes can last 20 minutes. In severe cases, transient syncope, unconsciousness, epileptiform convulsions, transient cerebral hypoperfusion, or myocardial ischemia such as chest tightness and chest pain may occur. In some cases, falls may occur, resulting in fractures; in others, hypotension occurs without any aura, but with repeated syncope as the main manifestation, or sudden standing and direct fall. The cause of occurrence is mainly related to age, and the older the patient is, the higher the probability of occurrence. There are also degenerative changes in various systems in the elderly, especially the cardiovascular system, the nervous system function decline, the sensitivity of the receptors regulating blood pressure is reduced, can not make the corresponding adjustment with the change of body position, in addition, vascular sclerosis, reduced compliance, can not quickly expand to ensure cerebral blood perfusion, myocardial reserve compensation capacity is insufficient, myocardial ischemia. Drug factors: the elderly often suffer from a variety of diseases, most of the time taking a variety of drugs to treat different diseases, the role of the drug itself, the interaction between drugs and drugs, can produce enhanced, synergistic, antagonistic reactions, such as a variety of psychotropic drugs, sedative and tranquilizer, tricyclic antidepressants, prostate drugs, diuretics, antitumor drugs and so on. Disease factors: neurological diseases, cardiovascular diseases, diabetes, digestive system diseases, hypoautonomia, etc., especially when the patient can not eat normally, diarrhea and other body fluid loss, weakness is more likely to occur. 2, recumbent hypertension: refers to normal blood pressure in the upright position, blood pressure increases when lying down, systolic blood pressure greater than 140 mmHg, or diastolic blood pressure greater than 90 mmHg should be considered. It is common in elderly people with reduced vascular function and poor regulation ability, and it is also common in people with neuropathy in type 2 diabetes. Symptoms may include chest tightness in the recumbent position, which is relieved after sitting up, or headache and head swelling, which is relieved or relieved after getting up, or some patients may not have any discomfort and can only be detected by blood pressure monitoring or blood pressure measurement in the recumbent position, which is more insidious. The reason for this may be the increase in cardiac blood return and cardiac output in the recumbent position, when the sympathetic nervous system is activated and catecholamines and other blood pressure hormones are released, while the physiological regulation of the elderly is sluggish or diminished, resulting in increased blood pressure. 3, recumbent hypertension – upright hypotension syndrome: as the name implies, two blood pressure states exist simultaneously, commonly in the elderly and type 2 diabetic patients, the incidence is less, blood pressure is high and low, fluctuating. For this hypertension patients need to be extra cautious in antihypertensive treatment. 4, upright hypertension: refers to the patient in the prone position, squatting position converted to upright position after 3 minutes of systolic blood pressure rise more than 20mmHg, or diastolic blood pressure more than 10mmHg, or only systolic blood pressure rise can also be diagnosed. It is common in two cases: first, the blood pressure is normal in the sitting position, but the blood pressure rises immediately after changing from the prone position to the standing position, but the blood pressure can return to normal after 20-30 minutes; second, the blood pressure is high in the sitting position, and the blood pressure rises for a short time after changing from the prone position to the standing position, and then the blood pressure will fall, but it is still in the state of hypertension. 5, early morning hypertension: refers to the patient’s home self-measurement blood pressure greater than or equal to 135/85mmHg within 1 hour after waking up, or ambulatory blood pressure records blood pressure greater than or equal to 135/85mmHg 2 hours after waking up, or blood pressure greater than or equal to 140/90mmHg measured in the hospital office at 6-10 am. 6, blood pressure morning peak: refers to the average value of systolic blood pressure within 2 hours after the patient wakes up – The average value of the systolic blood pressure during nighttime sleep, including the lowest value of 1 hour (24-hour ambulatory blood pressure monitoring data is required) value greater than or equal to 35mmHg is called morning peak blood pressure. The reason for the above two phenomena is that when the body changes from sleep to wakefulness, sympathetic nerve activity increases and parasympathetic nerve activity decreases, which is also known as the time of alternation of yin and yang in Chinese medicine. These factors together lead to a rapid rise in blood pressure after waking. 7, postprandial hypotension: refers to 2 hours after the meal systolic blood pressure than before the meal fell by more than 20mmHg, or before the meal systolic blood pressure in more than 100mmHg, after the meal systolic blood pressure fell to 90mmHg or less, if the postprandial blood pressure is only mildly reduced, but there is chest tightness, syncope, transient impaired consciousness, pale, weakness and other symptoms also belong to postprandial hypotension. It occurs in elderly people who are frail, bedridden for a long time, taking various antihypertensive drugs, psychiatric drugs, and anti-anxiety drugs. It is especially likely to occur in elderly people with diabetes, Parkinson’s disease, and neurodegenerative diseases. The main reason for this is that the pressure receptors of the elderly are less sensitive, and the sympathetic nerve activity after meals is insufficient to adjust the distribution of blood flow to the internal organs after meals, resulting in reduced blood flow to the heart and brain, reduced cardiac output, and lower blood pressure, as well as increased secretion of vasoactive peptides and other vasodilating substances secreted by the intestines, causing peripheral vasodilation and lower blood pressure. Therefore, the antihypertensive treatment of elderly hypertension must be meticulous and thoughtful, detailed understanding of the medical history and the drugs taken, the best home self-measurement of blood pressure, ambulatory blood pressure monitoring, suspected postural blood pressure changes, prone, standing and postprandial blood pressure measurement, in order to understand whether the patient has upright hypotension, upright hypertension, prone hypertension, early morning hypertension, blood pressure morning peak, postprandial hypotension, etc., more fine management of the blood pressure of elderly people to further reduce the occurrence of cardiovascular and cerebrovascular accidents and fall injuries.