Background Hypertensive target organ damage (TOD) is the main reason for mortality or disability in elderly hypertensive patients.The studies on TOD of hypertension in Asia,especially in Chinese elderly hypertensive patients,are very limited.The aim of this study was to evaluate the prevalence and correlative factors of TOD in older Chinese hypertensive inpatients.Methods This is a retrospective survey and data were collected from the computerized medical files of hypertensive inpatients from January of 1993 to December of 2008.The analysis was done on 17 682 inpatients,aged 60 years or older,with a diagnosis of essential hypertension (EH).The evidence of hypertensive TOD and associated factors with TOD were collected.Results The prevalence of any hypertensive target organ involvement among these subjects was high.In multivariable Logistic regressions adjusted for potentially confounding factors,older age,male gender,diabetes,EH grade 3,systolic blood pressure (SBP),and low-density lipoprotein cholesterol (LDL-C),were independently associated with coronary artery disease.Age,duration of EH,EH grade 3,SBP,pulse pressure (PP),and homocysteine (Hcy) were independently associated with cerebrovascular disease.Age,diabetes,duration of EH,EH grade 3,SBP,PP and estimated glomerular filtration rate (eGFR) were independently associated with chronic kidney disease.Male gender,EH grade 3 and SBP were independently associated with aortic dissection.Conclusions The prevalence of hypertensive TOD is high in older Chinese hypertensive inpatients.Various cardiovascular risk factors are associated with hypertensive TOD.The level of SBP and severe hypertension (grade 3 hypertension) are common independent risk factors of TOD.