Objective To explore the occurrence of metabolic syndrome (MS) in elderly patients with hypertension in Urumqi region, Xinjiang, and investigate their quality of life and its related influencing factors. Methods A total of 1 566 elderly patients with hypertension admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2021 to July 2022 were enrolled in the study. The occurrence of MS was investigated, and the status quo of quality of life was investigated with 36-item short-form health survey (SF-36). According to occurrence of MS or not, the patients were divided into MS group (n=854) and non-MS group (n=712), and the SF-36 score was compared between the two groups. The patients were also assigned into excellent group (n=669) and moderate-poor group (n=897) according to their SF-36 score. SPSS statistics 19.0 was used for data processing. Based on different data type, Chi-square test or rank sum test was employed for intergroup comparison. Multivariate logistic regression model was applied to analyze the influencing factors for quality of life in elderly patients with hypertension. Results Among the 1 566 elderly patients with hypertension, 54.53% (854/1 566) were diagnosed with MS, and 42.72% (669/1 566) had excellent overall quality of life, and 57.28% (897/1 566) had moderate-poor quality of life. The quality of life was significantly lower in the MS group than the non-MS group (P<0.05). Multivariate logistic regression analysis indicated that living alone (OR=2.323,95%CI 1.642-3.287), multiple medication (OR=2.568,95%CI 1.558-4.233) and comorbidity of ≥3 chronic diseases (OR=2.568,95%CI 1.558-4.233) were the risk factors affecting the quality of life in elderly patients with hypertension, and the frequency of going out (OR=0.257,95%CI 0.109-0.604) and physical exercise (OR=0.176,95%CI 0.062-0.499) were the protective factors of quality of life. Conclusion The overall quality of life in elderly hypertension patients in Urumqi region, Xinjiang is not good, and it is necessary to pay more attention to those living alone and those complicated with ≥3 types of chronic diseases. Clinicians should timely adjust the drug dosage and regimen for multiple drug users, and encourage the patients to increase the social activities and physical exercise. In addition, MS is quite common in hypertension patients in this region, and its complication will further reduce their quality of life, thus in clinical practice, prevention and control of MS is necessary.