Objective: To analyze the clinical research and nursing risk prevention of postural hypotension and postural hypertension in elderly patients with hypertension. Methods: A total of 256 elderly patients with hypertension in Beijing Shijitan Hospital from December 2018 to December 2019 were selected. The blood pressure and heart rate of patients in lying and standing position were measured. According to the results, the patients were divided into a normal group (n=155), a hypotension group (n=68) and a hypertension group (n=33). Meanwhile, the blood pressure and the incidence of cardiovascular and cerebrovascular diseases in different age groups were compared. Results: The incidence of coronary heart disease, stroke, dyslipidemia and blood glucose in patients ≥80 years old was higher than that in patients aged 60–79 years old (P<0.05). One hundred and twenty cases (46.88%) were complicated with coronary heart disease, of which 43 cases (60.56%) were ≥80 years old; 156 cases (60.94%) were complicated with dyslipidemia, of which 51 cases (71.83%) were ≥80 years old; there was no significant difference in the incidence of cardiovascular and cerebrovascular diseases between the hypertension group and the hypotension group (P>0.05). The incidence of cardiovascular and cerebrovascular diseases in the normal postural blood pressure group was significantly lower than that of the postural hypertension group and the postural hypotension group (P<0.05). Conclusion: Among the elderly patients with hypertension, there is a certain incidence of postural hypertension and postural hypotension. Most of them are accompanied with cardiovascular and cerebrovascular diseases and diabetes mellitus. Therefore, the clinical nursing risk program should be strengthened to ensure the nursing safety of the patients.