Abstract：Objective：To observe the clinical effect of Huoxue Shumai Decoction combined with Levamlodipine Besylate Tablets in the treatment of elderly hypertension. Methods： A total of 86 elderly patients with hypertension admitted to Henan Integrative Medicine Hospital from October 2020 to October 2022 were randomly divided into the control group and the observation group， with 4 cases in each group. The control group was treated with Levamlodipine Besylate Tablets ， while the observation group was treated with Huoxue Shumai Decoction in addition to the control group. Both groups were treated for eight weeks. Traditional Chinese medicine （TCM） syndrome scores， circadian rhythm of blood pressure， average daytime systolic blood pressure （dSBP）， average daytime diastolic blood pressure （dDBP），average nighttime systolic blood pressure （nSBP），average nighttime diastolic blood pressure （nDBP）， morning peak blood pressure， arterial function indicators [pulse wave velocity （PWV）， noninvasive central systolic blood pressure （CSP）， and augmentation index （AI）]， and endothelial function indicators [endothelin-1 （ET-1） and nitric oxide （NO）] levels were compared before and after treatment in the two groups. The clinical effects and incidence of adverse reactions were evaluated in the two groups. Results：The total effective rate in the observation group was 90.70% （9/4），which was higher than that of 72.09% （1/4） in the control group （P＜ 0.05）. After treatment，TCM syndrome scores，dSBP，dDBP，nSBP，nDBP，morning peak blood pressure，CSP， and ET-1 levels were all decreased when compared with those before treatment （P＜0.05）， PWV and AI decreased （P＜0.05），and NO levels increased （P＜0.05）；TCM syndrome scores，dSBP，dDBP，nSBP，nDBP， morning peak blood pressure， CSP， and ET-1 levels in the observation group were lower than those in the control group （P＜0.05），while PWV and AI in the observation group were lower than those in the control group （P＜0.05）； the level of NO in the observation group was higher than that in the control group （P＜0.05）. After treatment， the proportion of dipper hypertension in the observation group was higher than that before treatment（P＜0.05）； the proportion of non-dipper hypertension was lower than that before treatment（P＜0.05）； the proportion of dipper hypertension in the observation group was higher than that in the control group after treatment （P＜0.05）. There was no significant difference in the proportion of extreme and reserved dipper hypertension between the two groups before and after treatment，as well as in the proportion of dipper and no-dipper hypertension in the control group （P＞0.05）. No adverse reactions occurred in both groups. Conclusion： The combination of Huoxue Shumai Decoction and Levamlodipine Besylate Tablets can improve the circadian rhythm of blood pressure and clinical symptoms in elderly patients with hypertension，effectively control morning peak blood pressure，improve vascular endothelial and arterial function，and have significant clinical effects and high safety.