Abstract: Objective To investigate the differences of echocardiographic parameters of myocardial work in middle-aged and elderly hypertensive patients with different age, gender and hypertension grade. Methods Three hundred and sixty patients with essential hypertension over 40 years old who admitted to Zhongshan Xiamen Hospital of Fudan University from October 2021 to June 2023 were included. According to age, the patients were divided into two groups: 40-54 years old group（n=180）, and ≥55 years old group（n=180）. Each group was further divided into 6 subgroups according to gender and hypertension grade（n=30 in each subgroup）. The parameters related to myocardial work assessed by transthoracic echocardiography were compared between groups and within groups. Results Before 55 years old, the global constructive work（GCW） of female patients with grade 1 hypertension was higher than that of male patients （2 623.53±222.46）vs（2 418.83±393.89） mmHg%,t=2.478,P=0.017, the absolute value of global longitudinal strain（GLS）, global work index（GWI）, GCW and global wasted work（GWW） of female patients with grade 2 and 3 hypertension were higher than those of male patients（all P＜0.05）. There was also a gender difference in global work efficiency（GWE） in patients with grade 2 hypertension（t=2.698,P=0.009）. After 55 years old, there were no gender differences in all parameters in patients with grade 1 hypertension（all P＞0.05）. The GCW and GWI of patients with grade 2 and 3 hypertension in female group were higher than those in male group（all P＜0.05）. The absolute value of GLS in patients with grade 2 hypertension was also higher in women than that in men（t=2.176,P＜0.05）. Comparison between the same gender showed that there was no significant difference in work parameters between different grades of hypertension in females and between 2 and 3 grades of hypertension in males（all P＞0.05）. In male patients with grade 2 hypertension, GWW in the population over 55 years old was higher than that in the population under 55 years old, while GWE was opposite（both P＜0.05）. The effect of different grades of hypertension on male patients was mainly manifested in GLS（P＜0.05）, whlie on female patients was mainly manifested in GWI after 55 age（P＜0.05）. Conclusion The difference of myocardial work in middle-aged and elderly hypertensive groups is related to gender and age, and the influence of the hypertension grade on genders is also different.