Objective To investigate the relationship between plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and myocardial remodeling in hypertensive patients over 80 years old. Methods A total of 113 patients (>80 years old) admitted in our hospital from Feb. 2012 to Apr. 2016 were enrolled in this study. They were divided into hypertension group (n=71) and normal blood pressure (control) group (n=42), and the former group was further assigned into 3 subgroups according to their systolic blood pvessure (SBP) and diastolic blood pressure (DBP), that is, level 1 subgroup (SBP 140-159 mmHg, DBP 90-99 mmHg, n=5), level 2 subgroup (SBP 160-179 mmHg, DBP 10-109 mmHg, n=17) and level 3 subgroup (SBP ≥180 mmHg, DBP ≥110 mmHg, n=49). The plasma NT-proBNP level was determined and compared among the groups and subgroups, and its correlation with myocardial remodeling indicators was analyzed. Results With the increase of blood pressure levels, the plasma NT-proBNP level was gradually elevated. Except the level 1 subgroup and control group, significant differences were found in the plasma level among other groups (P<0.05). The NT-proBNP level was positively correlated to hypertension duration (r=0.508), 24-hour DBP (r=0.312), left ventricular mass index (r=0.301), interventricular septum thickness (r=0.285), and negatively to E/A ratio (r=-0.376, all P<0.01). Conclusion A good correlation is observed between NT-proBNP level and myocardial remodeling in hypertensive patients aged over 80 years.