Objective To explore the effect of long-term blood pressure variability and anti-hypertensive treatment on arterial stiffness. Methods A total of 411 elderly patients with essential hypertension who were treated and managed in our hospital from January to June 2017 were enrolled in this study. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were used as indicators to evaluate arterial stiffness. Linear regression analysis was employed to analyze the correlations of blood pressure index and long-term blood pressure variability (BPV) with baPWV and ABI. BPV was expressed as systolic blood pressure standard deviation (SBP_SD). SPSS statistics 26.0 was applied for data analysis. The efficacy of anti-hypertensive therapy and the effect of antihypertensive therapy on arterial stiffness were analyzed by student′s t test. Results In those elderly patients with hypertension, 3 years′ anti-hypertensive treatment resulted in significantly decreased average systolic blood pressure [SBP, (131.78±7.36) vs (142.92±17.14) mmHg(1 mmHg=0.133 kPa)], diastolic blood pressure [DBP, (80.22±6.31) vs (81.49±10.01) mmHg], pulse pressure [PP, (51.57±7.81) vs (61.43±14.06) mmHg] and mean artery pressure [MAP, (97.41±5.57) vs (101.97±10.98) mmHg], obviously reduced fasting plasma glucose [FPG, (5.30±1.67) vs (5.81±1.69) mmol/L], total cholesterol [ (3.85±0.95) vs (4.42±0.90) mmol/L] and triglyceride [(1.27±0.68) vs (1.79±1.13) mmol/L], but remarkably elevated high-density lipoprotein cholesterol [(1.35±0.31) vs (1.21±0.31) mmol/L] when compared the corresponding values before treatment (all P<0.05). No such statistical change was seen in low-density lipoprotein cholesterol level before and after treatment. After adjustment for confounding factors, SBP, PP, MAP and SBP_SD were positively correlated with baPWV (β=10.390,5.500,14.940,11.110, all P<0.05) and negatively with ABI (β=-0.002, -0.001, -0.002, -0.003, all P<0.05 ) in the patients. DBP was only positively correlated with baPWV (β=8.690, P<0.05), but had no correlation with ABI. After antihypertensive treatment, baPWV was decreased from (1 782.70±308.87) cm/s to (1 732.43±261.73) cm/s, and ABI was increased from (1.12±0.10) to (1.14±0.08), with statistically differences (both P<0.05). Among them, baPWV showed a downward trend in gender and age stratifications, and significant difference was seen compared with that before antihypertensive treatment (P<0.05). ABI in the female patients and those aged 60-70 years was significantly different from that before anti-hypertensive treatment (P<0.05). The SBP difference and DBP difference before and after treatment were positively correlated with the difference of baPWV (β=3.000,3.290, P<0.05), but not with the difference of ABI. Conclusion SBP_SD is an influencing factor of arterial stiffness. The antihypertensive treatment and comprehensive management of elderly hypertensive patients can significantly improve their baPWV value, but the effect on ABI needs further research to clarify.