Objective To determine the risk factors for peripheral arterial occlusive disease (PAOD) in the very old patients with hypertension. Methods Totally 121 very old hypertensive subjects with age over 80 years and systolic blood pressure ≥140mmHg admitted in our department from August 2012 to August 2013 were enrolled in this study. Their clinical data were collected. Lower extremity arteries ultrasonography and ambulatory 24-hour blood pressure monitoring were carried out. They were divided into PAOD group (n＝49) and non-PAOD group (n＝72) according to the results of lower extremity artery ultrasonography. Independent samples t-test, correlation analysis and logistic regression analysis were employed to analyze the risk factors. Results The morbidity of PAOD was 40.5% in the very old patients with hypertension. PAOD patients had significantly higher age, incidence of coronary heart disease (CHD), serum creatinine and glycosylated hemoglobin A1c (HbA1c) level (P＜0.05). Logistic regression analysis revealed that age, CHD, average day diastolic blood pressure (dDBP) and HbA1c were independent risk factors for PAOD (regression equation: PAOD＝-12.169＋0.131×age＋1.341×CHD -0.069×dDBP＋HbA1c×0.692). Conclusion The morbidity of PAOD is significantly higher in the very old patients with hypertension than in ordinary population. Age, CHD, dDBP and HbA1c are independent risk factors for PAOD.