Aim To evaluate the relationship between ambulatory pulse pressure(ABP) and ischemic stroke in the very elderly hypertension patient.Methods 131 patients with essential hypertension were divided into two groups: 57 patients with ischemic stroke and 74 patients without ischemic stroke.ABP,casual blood pressure(CBP) and cerebral CT(or MRI) were examined in all subjects.The data of age,gender et al,were obtained for each of the patients.Results The age,gender had no statistical significance between the two groups.Systolic blood pressure(SBP),pulse pressure(PP),isolated systolic hypertension(ISH)were significantly higher in the ischemic stroke group than in group without ischemic stroke(166.82±24.00 mmHg vs 154.81±23.71 mmHg,81.29±17.44 mmHg vs 72.41±17.32 mmHg,P<0.01);There was significant difference in day mean systolic blood pressure(dMSBP),day mean diastolic blood pressure(dMDBP),circadian rhythm between the two groups(137.57±19.66 mmHg vs 132.00 ±15.09 mmHg,71.92±12.47 mmHg vs 68.29±10.82 mmHg,P<0.05).Conclusion Abnormal blood pressure especially SBP,PP,and circadian rhythm have direct connection with ischemic stroke in the very elderly hypertension patient.