Aim To investigate the relationship between plasma β2-microglobulin (β2-MG), ankle-brachial index (ABI) and blood pressure variability (BPV) in elderly patients with hypertension. Methods 423 elderly patients with essential hypertension were selected. According to the plasma level of β2-MG, the patients were divided into two groups:β2-MG＜2 mg/L group and β2-MG≥2 mg/L group, and BPV difference was compared between the groups. In addition, according to the ABI value, the patients were divided into two groups:ABI＜0.9 group and ABI≥0.9 group, and the differences of BPV and β2-MG were compared between the groups. Respectively taking 24 h systolic blood pressure variability (24hSBPV) and 24 h diastolic blood pressure variability (24hDBPV) as the dependent variable, other variables as independent variable, the regression models were established by stepwise regression method to analyze the relationship between plasma β2-MG, ABI and BPV. Results 24hSBPV, 24hDBPV and 24 h mean artery blood pressure in β2-MG≥2 mg/L group were significantly higher than those in β2-MG＜2 mg/L group (23.33%±5.12% vs 20.39%±4.74%, 17.10%±4.98% vs 15.40%±4.60%, 94.36±12.33 mmHg vs 90.67±14.52 mmHg, all P＜0.001). 24hSBPV, 24hDBPV and plasma β2-MG level in ABI＜0.9 group were significantly higher than those in ABI≥0.9 group (24.34%±6.02% vs 19.45%±5.49%, 17.27%±5.18% vs 14.62%±4.95%, 2.87±1.20 mg/L vs 1.56±0.85 mg/L, all P＜0.001). Multiple linear regression analysis showed that 24hSBPV was positively correlated with age, plasma β2-MG level and low density lipoprotein, and negatively correlated with ABI, 24hDBPV was positively correlated with age, plasma β2-MG level, and negatively correlated with ABI. Conclusions In elderly patients with hypertension, BPV increases with age. The increase of BPV can aggravate the degree of atherosclerosis, and is closely related to the degree of target organ damage.