Aim To study the changes of sex hormones, endothelial function and fibrinolytic activity in elderly hypertensive patients. Methods We selected 66 (women 34, men 32) stage Ⅰ-Ⅱ elderly hypertensive patients and 32 (women 16, men 16) elderly healthy individualsas subjects. Then their serum concentration of estradiol (E 2), testosterone (T) were measured with radio-immunoassay, plasma concentration of von Willebrand factor (vWF) were determined by enzyme-linked immunosorben assay, and tissue plasminogen activator (t PA) activity, plasminogen activator inhibitor (PAI) activity were examined by photometric techniche with chromogenic substrate. Results Elderly women with hypertension had significantly lower E 2, t PA activity and significantly higher vWF and PAI activity when compared with elderly healthy women. Elderly hypertensive men had significantly lower T, t PA activity and significantly higher vWF and PAI activity when compared with elderly healthy men. E₂ correlated negatively with vWF in elderly hypertensive women. Conclusion This study suggested that E 2 level was significantly decreased in elderly hypertensive women, and T level was significantly decreased in elderly hypertensive men. They both had significantly endothelial dysfunction and impaired fibrinolysis. Extradiol may exert a beneficial effect on vascular endothelium, then protect elderly women against hypertention.