Abstract: Objective To analyze the correlation between orthostatic hypertension and urinary microalbumin excretion rate and left ventricular mass index in middle-aged and elderly patients. Methods From January 2018 to July 2019, 556 middle-aged and elderly patients with essential hypertension who were treated in the Third People's Hospital of Hangzhou were selected as the research subjects. The observation group(n=125) was orthostatic blood pressure increase(orthostatic hypertension) patients. The patients whose systolic blood pressure change less than 20 mm Hg, were considered with normal orthostatic blood pressure, served as the control group(n=431). The evaluation included 24 h urine microalbumin excretion rate and left ventricular mass index and association of patients with orthostatic hypertension. Results The urine microalbumin excretion rate[(22.3±3.1) mg/24 h] and the left ventricular mass index[(111.3±5.8) g/m²] in the observation group compared with the control group[(14.2±3.7) mg/24 h and(94.8±5.7) g/m²]. All of them increased significantly, and the differences were statistically significant(all P<0.001). Correlation analysis showed that orthostatic systolic blood pressure and orthostatic diastolic blood pressure had a linear positive correlation with urinary microalbumin excretion rate and left ventricular mass index. There were statistical significances(all P<0.05). The regression equations were Y=30.62+0.40 X; Y=25.95+0.90 X; Y=26.02+0.53 X; Y=27.88+1.33 X. Conclusion There may be a correlation between orthostatic blood pressure elevation in middle-aged and elderly patients with essential hypertension and abnormalities in urinary microalbumin excretion and abnormal left ventricular mass index, suggesting that target organ damage may be present. Early intervention should be considered in clinical practice.