Objective: To analyze the cardiac ultrasound performance and electrocardiogram findings of elderly patients with hypertensive heart disease (HHD). Methods: Among 88 cases of elderly patients with HHD, electrocardiogram was used in 44 cases, the other 44 cases were checked by B ultrasound, an the diagnoses of 2 checking methods were compared. Results: For HHD patients, the detection rate of left ventricular enlargement, left ventricular hypertrophy, dilation of aorta by B-ultrasound was obviously higher than electrocardiogram (P<0.05). The detection rate of left atrial enlargement, aortic elasticity decreasing by B-ultrasound had no significant differences compared with electrocardiogram (P>0.05). Conclusions: The main performances of cardiac ultrasound of elderly patients with HHD are ventricular hypertrophy and left ventricular enlargement, as well as left atrial enlargement and dilation of aorta. Cardiac ultrasound has higher sensitivity in early diagnosis of HHD, so it is worthy of clinical promotion.