Objective To investigate the cardiac structure and function, and renal function in elderly hypertensive patients with diabetes mellitus. Methods A total of 206 over 60-year-old patients hospitalized in our department from April 2010 to May 2012 were enrolled in this study. They were divided into hypertension group [group A, n＝98, (72.1±7.3) years) and hypertension and diabetes group [group B, n＝108, (70.7±7.5) years]. And another 103 age- and sex-matched healthy individuals served as normal control. Hypertension and diabetes were confirmed by their international or national diagnostic criteria. All patients were observed for the systolic blood and diastolic blood pressure, fasting blood glucose (FBG), post blood glucose (PBG), glycated hemoglobin (HbA1c), triglycerides, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, serum uric acid, creatinine, serum cystatin, 24-hour urinary albumin. All patients received echocardiography for left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT greater), relative wall thickness (RWT), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and E/A ratio. Results The serum level of uric acid and urinary albumin-positive rate were significantly higher in group B than in the other two groups (P＜0.05). The patients of group B also had significantly higher levels of FBG, PBG and HbA1c than the other two groups (P＜0.05). The values of LVEDD, IVST, LVMI, RWT and PWT were significantly higher in group A and B than in group C (P＜0.05), and that of LVEDD, IVST, LVMI, PWT and RWT in group B even higher than in group A (P＜0.05). The E/A ratio were significantly lower in group A and B than in control (P＜0.05), with that of group B significantly lower than that of group A (P＜0.05). Conclusion For the elderly hypertensive patients with diabetes, glucose metabolic disorders may be associated with left ventricular hypertrophy and decreased diastolic function. In clinical practice for hypertensive patients with diabetes, better glucose control should be achieved, and intervention for multiple risk factors should be strengthened to reduce the incidence of cardiovascular complications and to improve prognosis.