Abstract: Objective To evaluate the association of long-term blood pressure variability and renal damage in elderly patients with hypertension in Shanghai. Methods The essential hypertensive patients who were followed up from October 1, 2020 to September 30, 2021 and diagnosed with renal damage were assigned to case group. The control group was selected from patients who were not diagnosed with renal damage by 1∶1 matching according to age（±2 years）, gender and community health center of patients in the case group. The data of visit-to-visit automated office blood pressure was retrospectively analyzed. The logistic regression model was used to analyze the association of long-term blood pressure variability and renal damage. Four different indices of blood pressure variability and subgroup analysis were applied to ascertain the stability of the association. Results A total of 936 subjects were finally included in the analysis, 468 in case group and 468 in control group. The standard deviation of systolic blood pressure（SSD）, coefficient of variation of systolic blood pressure（SCV）, average reality variability of systolic blood pressure（SARV） and variation independent of mean systolic blood pressure（SVIM） in the case group were significantly higher than those in the control group（all P＜0.05）, but there was no significant difference between the two groups referring to diastolic blood pressure. After adjusting the confounding factors, the logistic regression model showed that the risk of renal damage in abnormal SSD group, abnormal SCV group, abnormal SARV group and abnormal SVIM group was 1.388（95%CI 1.055-1.825）, 1.385（95%CI 1.049-1.829）, 1.512（95%CI 1.134-2.015）, 1.404（95%CI 1.067-1.847） times higher than those in normal group respectively. However, no significant association was found related to diastolic blood pressure. The result was basically consistent when the blood pressure variability indices were included as continuous variable in the model or subgroup analysis was conducted, which indicated that the association was relatively stable. Conclusions Long-term systolic blood pressure variability is associated with the risk of renal damage in elderly patients with hypertension. More attention should be paid to blood pressure variability in the community health management to help patients maintain blood pressure stability, which will have positive effect on preventing and mitigating the onset and progression of target organ damage in elderly hypertensive patients.