Objective To explore the effects of 24-hour dynamic blood pressure rhythm and insulin resistance metabolic disorder on postoperative cognitive dysfunction(POCD) in elderly hypertension patients. Methods Preoperative insulin resistance and 24-hour dynamic blood pressure in the elderly patients (age ≥60 years) undergoing noncardiac surgery were determined. Following WHO/ISH criteria for diagnosis of hypertension, 103 subjects were divided into four groups according to 24-hour dynamic blood pressure rhythm: dipper hypertension group (25 cases),dipper hypertension and insulin resistance metabolic disorder group (26 cases),non-dipper hypertension group (26 cases), and non-dipper hypertension and insulin resistance metabolic disorder group (26 cases). All subjects were evaluated by Mini-Mental State Examination (MMSE) preoperatively and on day 7 postoperatively. Results The MMSE score was significantly lower in non-dipper hypertension and insulin resistance metabolic disorder group than in dipper hypertension and insulin resistance metabolic disorder group, dipper hypertension group and non-dipper hypertension group (24.3±1.3, 27.3±1.7,28.3±0.6,26.8±1.3, respectively, P<0.05).Conclusion A reduction and disappearance of blood pressure circadian rhythm complicated with insulin resistance is associated synergistically with the damage of postoperative cognitive function in elderly hypertension patients.