Hypertension in the elderly is a consequence of several aging processes, and it is important to understand characteristics of elderly hypertension for diagnosis and treatment. Hypertension in the elderly is characterized by isolated systolic hypertension and increased pulse pressure in response to aortic stiffness. Decline in barorelfex, left ventricular hypertrophy, and impaired control of body fluid volume also need to be considered in the treatment of elderly hypertension, as these alternations may result in reduced tissue circulation and blood flow reserve. Target blood pressure of the elderly is < 140/90 mmHg, as suggested by the results of recent mega-trials. It is necessary to gradually decrease blood pressure in the elderly, as they might have reduced tissue circulation and impaired auto-regulation of blood flow.