Hypertension is the most widespread cardiovascular disease in the world, and the most important risk factor for stroke and coronary heart disease in our population. According to epidemiological surveys, the prevalence of hypertension among the elderly in China has reached 40%-60%, and such a large group of patients makes the national medical resources and the prevention and treatment of cardiovascular diseases face a serious challenge. For this reason, this paper summarizes the treatment countermeasures for hypertension in the elderly as follows: 1. Once it was thought that with the growth of age, the rise in blood pressure, especially systolic blood pressure, was a good sign of aging, resulting in the elderly having hypertension without active treatment. Recently, more and more studies have proven that cerebrovascular events occurring in simple systolic hypertension are significantly higher. The benefit of antihypertensive treatment is also more obvious. Evidence-based medicine proves that hypertension in the elderly requires aggressive treatment, which can lead to a significant reduction in fatal and non-fatal cardiovascular events. (1) Elderly hypertensive patients without special comorbidities usually have a systolic blood pressure <150 mm Hg and diastolic blood pressure ≥60-65 mm Hg. (2) Those with diabetes mellitus or renal disease should be controlled at 130/80 mm Hg. (3) Active blood pressure lowering is not advocated in the acute phase of stroke, but in the acute phase of cerebral infarction, the blood pressure should be controlled at 160-180/90-105 mm Hg. ~In the acute phase of cerebral hemorrhage, the blood pressure should be controlled at 150-160/90-100 mm Hg. Once the condition of cerebral hemorrhage or cerebral infarction is stabilized, conventional antihypertensive treatment should be resumed gradually and the blood pressure should be controlled at 150/90 mm Hg or less. 3. Non-pharmacological treatment of hypertension in the elderly is more effective Grade 2 low- and intermediate-risk patients are treated with non-pharmacological treatment first, and some of them can reach the blood pressure standard. Overweight, alcohol consumption and high-sodium diet are the 3 major risk factors of hypertension, and they are more prominent in the elderly than in the non-elderly, and a full range of interventions are needed for unreasonable lifestyles. The implementation of these measures, such as low salt, weight reduction, smoking cessation, alcohol restriction and exercise, is important to control and stabilize blood pressure and is the cornerstone of drug therapy. 4, the special nature of the application of antihypertensive drugs for elderly hypertension According to the special physiological changes in the elderly, the differences in the efficacy of antihypertensive drugs, drug selection should be individualized. (1) Systolic hypertension in the elderly has the characteristics of low renin, low sympathetic activity, high volume and high output, diuretics should be preferred (lowering systolic blood pressure is better than lowering diastolic blood pressure). Calcium antagonist (CCB), also can choose angiotensin II receptor antagonist (ARB). (2) With diabetes, diabetic nephropathy, renal insufficiency [Cr<225.2 μmol/L (3 mg/d)], ACEI is preferred, ARB can prevent the development of nephropathy, and diuretics can be added if it is difficult to control. (3) With coronary artery disease and myocardial infarction, β-blockers, ACEI, and long-acting calcium antagonists are preferred, while short-acting nifedipine cannot be used. (4) With left ventricular hypertrophy, ACEI, α-blockers, calcium antagonists can be used. (5) ACEI, diuretics, alpha-blockers are preferred for those with heart failure. Amlodipine or felodipine are available for special cases. Nifedipine is contraindicated. (6) With renal failure, available beta-blockers. (7) With asthma, chronic obstructive pulmonary disease, intermittent claudication preferred calcium antagonists, β-blockers are prohibited. (8) Prostate enlargement is appropriate to use alpha-blockers. (9) with osteoporosis, preferred diuretics other than tab diuretics is more appropriate, can help protect the bone structure. (10) The elderly should not use central antihypertensive drugs such as reserpine, colistin and methyldopa to avoid symptoms such as forgetfulness, dreaminess and depression. (11) The elderly are prone to postural hypotension or postprandial hypotension. Strong diuretics, alpha-blockers and ganglion blocks should be avoided to prevent insufficient blood supply to vital organs. In terms of drug dosage form, long-acting dosage form should be the main one, which can not only improve compliance, but also smoothly lower blood pressure, reduce fluctuation of blood pressure and protect target organs. Drug therapy should be started in small doses, and gradually increase and slowly lower blood pressure. The elderly are often multi-disease coexistence, multi-drug combination, high incidence of adverse drug reactions, should give priority to the sequential method, which can reduce the type of medication and adverse drug reactions, and the sequential method is to replace one drug with another when it is ineffective, and then use a combination of drugs when multiple drugs alone are ineffective. Combination of drugs: emphasize low-dose combination, which can increase the efficacy and reduce the adverse drug reactions. 1, diuretics + ACEI or angiotensin II receptor antagonist (ARB): diuretics activate the renin angiotensin system and enhance the combination of the latter two drugs, and the adverse effects of diuretics such as low potassium and high uric acid are offset by ACEI (high potassium) and ARB (excretion of uric acid). 2, diuretics + beta-blockers: the side effects of shrinking blood vessels and sodium storage of beta-blockers are reliably offset by diuretics, and the side effects of diuretics increasing heart rate can be offset by beta-blockers. 3, β-blockers + dihydropyridine calcium antagonists: β-blockers counteract calcium antagonism heart rate acceleration, calcium antagonists can overcome the vasoconstrictive effect of β-blockers. 4, calcium antagonist + ACEI or ARB: calcium antagonist directly dilates arteries, ACEI can dilate both arteries and veins, there is a synergistic effect, ACEI dilates veins to counteract the ankle edema caused by calcium antagonist. 5, calcium antagonists + diuretics, β-blockers + ACEI or ARB is less reasonable combination: because calcium antagonists and diuretics have the effect of increasing the heart rate combined poorly. β-blockers are better for people with low renin, while ACEI and ARB are better for people with high renin, so the combination is not reasonable. The main pathogenesis of simple systolic hypertension in the elderly is reduced compliance of the large arteries, which decreases the ability of the large arteries to expand elastically, resulting in a significant increase in systolic blood pressure without buffering, and a decrease in diastolic blood pressure due to reduced elastic retraction of the large arteries. By improving aortic compliance, systolic pressure can be reduced and diastolic pressure can be increased, thereby reducing pulse pressure. Further therapeutic measures to improve large artery compliance are being explored. In addition, aerobic exercise and a low-salt diet can also improve aortic compliance.