Aim To explore the relationship between ideal cardiovascular health score (ICHS) and pulse pressure (PP) in rural middle-aged and elderly people in Liaoning Province, and to study the influencing factors of PP, so as to provide evidence for the prevention and treatment of arteriosclerosis. Methods A total of 952 rural residents aged between 50 and 80 in Beizhen City, Jinzhou City, Liaoning Province from October 2019 to December 2020 were selected as the research objects for descriptive research. A standardized questionnaire was used to collect the subjects' demographic characteristics, lifestyle, past disease history, medication history and other data. The height, body mass and blood pressure of the subjects were measured, and the biochemical indexes such as total cholesterol and fasting blood glucose (FBG) were detected. All subjects were scored with ICHS. The subjects were divided into normal PP group (n＝521) and elevated PP group (n＝431) according to the level of PP, and the differences of variables between the two groups were statistically analyzed; Then the samples were used by propensity score matching to make the two groups of subjects comparable, and the differences of variables between the two groups and the influencing factors of PP were analyzed. Results Compared with normal PP group, the ICHS was lower and the cardiovascular health level was poor in elevated PP group, the difference was statistically significant (P＝0.005). Blood pressure (P＜0.001) and FBG (P＝0.033) were also closely related to PP. Multivariate Logistic regression analysis showed that ICHS was the independent influencing factor of PP, and ideal ICHS was the protective factor of PP (OR＝0.5,5%CI:0.37～0.82, P＝0.003). Higher education level, women and people who didn't drink often had higher ICHS, that was, an ideal cardiovascular health level (all P＜0.05). Conclusions In Liaoning rural middle-aged and elderly population, the ICHS of PP increasing population is significantly lower than that of PP normal population, and the ideal ICHS is the protective factor of PP. Women, people with higher education and people who don't drink often have better cardiovascular health.