The elderly have a decline in the regulation of neuro-humoral-cardiocerebrovascular changes, and abnormal fluctuations of blood pressure are likely to cause damage in the target organ in the elderly with hypertension. Studies show that abnormal blood pressure variability (BPV) is a risk factor of stroke, cognitive dysfunction, cardiovascular disease, diabetes, and kidney disease. At the same time, BPV results in difficulty in steady reduction of blood pressure; therefore, it is necessary to monitor clinically the blood pressure variation in the elderly. This article reviews the research progress in BPV, associated diseases and influence of anti-hypertensive drugs in the elderly.