Objective To analyze the reproducibility of nocturnal blood pressure pattern in the elderly hypertensive patients by ambulatory blood pressure monitoring (ABPM) and evaluate its significance in clinical practice. Methods A total of 70 elderly essential hypertensive patients [45 males and 25 females, aged (83.57±5.37) years] admitted in the Department of Geriatrics from the Sixth People’s Hospital of Shanghai Jiaotong University were enrolled in this study. They underwent ABPM over two 24-hour periods within 4 weeks and other routine examinations. Their dipping patterns were classified as dippers (D), non-dippers (ND) and reverse-dipper (RD) according to their average systolic blood pressure at night compared to daytime. The short-term reproducibility was evaluated when above 3 different patterns used as continuous variables or categorical variables, and the differences among the reproducible and variable modes were analyzed. Results When the dipping patterns used as continuous variables, Bland-Altman’s plot showed that the reproducibility was good. While as categorical variables, overall 65.7% of the total 70 subjects (46/70) showed consistent dipping pattern during the 2 periods of ABPM, including 50.0% (14/28) confirming the identical RD, 76.5% (13/17) the identical D, and 76.0% (19/25) the identical ND (kappa＝0.482). Subjects who had RD, D and ND on the first ABPM but changed to another pattern on the second time accounted for 20.0%, 5.7%, and 8.6%, respectively. No significant difference was found among the persistent RD (group 1), D (group 2), ND (group 3) and those with variable dippers (group 4) in main clinical characteristics. Conclusion The nocturnal blood pressure pattern is moderately reproducible in the elderly hypertensive patients, regardless of as continuous or categorical variable, but the reverse-dippers have higher variability when compared to dippers and non-dippers. Therefore, we should not confirm the dipping status based on single period of ABPM. This study has not found any factor that may affect the noctunal dipping pattern.