Hypertension is common and prevalent in the elderly, mostly because of atherosclerosis and decreased vascular elasticity in the elderly, causing an increase in blood pressure. Hypertension in the elderly is defined as hypertension in people aged 60 years or older with systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg, and hypertension in the elderly should be treated according to its characteristics. Hypertension in the elderly has the following characteristics: (1) Blood pressure fluctuates more in hypertension in the elderly, especially systolic blood pressure. This is mainly caused by the reduced sensitivity of vascular pressure receptors in elderly patients. Therefore, blood pressure should be measured regularly during anti-hypertensive drug therapy and the amount of medication should be adjusted at any time. (2) Hypertension in the elderly is easily affected by postural changes, and the incidence of postural hypotension is higher, especially during anti-hypertensive drug therapy, which is also related to the hypersensitivity of pressure receptors. Therefore, drugs that can cause postural hypotension such as guanethidine, α1-blockers, tachyphylaxis, etc. should be used with caution. (3) The elderly are prone to pseudohypertension due to atherosclerosis, and these hypertensive patients are less tolerant of antihypertensive drugs, which may lead to serious adverse reactions and complications. At the same time, elderly hypertensive patients should not lower their blood pressure too fast or too low. (4) Hypertension in the elderly is mainly due to systolic blood pressure increase, which is more dangerous to the heart and more likely to occur hypertrophy and enlargement of the heart, heart failure, and also more likely to occur in strokes. (5) The β receptor responsiveness of the elderly is reduced, so the tolerance to β blockers is better, but there is a risk of bradycardia and congestive heart failure. (6) Elderly people are sensitive to blood volume reduction and sympathetic inhibition, which may be related to the weakened cardiovascular reflex in the elderly. (7) The initial dose and increasing dose of anti-hypertensive drug therapy for hypertension in the elderly are smaller than those in younger hypertensive patients, and the intervals should be longer than those in younger hypertensive patients. (8) The elderly have lower neurological function and are more prone to depression during drug therapy, so anti-hypertensive drugs acting on the central nervous system, such as colistin and methyldopa, should be avoided. Therefore, the use of Western medicine and Chinese herbal medicine for dialectical treatment is generally considered to be the best treatment for the characteristics of hypertension in the elderly.