Abstract: Objective To evaluate the efficacy and safety of 40 mg/d and 20 mg/d's atorvastatin lasted 24 months for elderly hypertension combined with coronary heart disease, and to provide a new reference for rational use of drug. Methods From January, 2016 to June, 2018, 150 patients with hypertension and coronary heart disease above 60 years old were randomly assigned to a high dose group and a conventional dose group, with 75 cases in each group. The high dose group was given 40 mg/d of atorvastatin, and the routine dose group was given 20 mg/d of atorvastatin, and two groups were measured before, twelfth months and twenty-fourth months after treatment. Blood pressure, blood lipids, carotid in-middle membrane thickness (IMT) and plaque area were recorded, and possible adverse drug reactions were analyzed by SPSS 21.0. Results There were significant differences in blood pressure, blood lipid, carotid artery and middle membrane thickness (IMT) and plaque area at the three time points before treatment, 12 and 24 months after treatment about the high dose group and the routine dose group (P<0.05). Compared with systolic pressure, blood lipid, IMT and plaque area, there were significant differences between the high dose group and the routine dose group at 12 and 24 months after treatment(P<0.05),but the diastolic pressure difference was not statistically significant (P>0.05), and there was no significant difference in adverse reaction rate between the two groups (P>0.05). Conclusion Forty mg/d and 20 mg/d atorvastatin can effectively remedy blood pressure, blood lipid, IMT and plaque area in patients with hypertension and coronary heart disease, and the effect of high dose improvement is better than that of the conventional dose group. There is no evidence that 24 months large dose of atorvastatin can increase the incidence of adverse reactions, and the results need further validation by high-quality multicenter randomized controlled trials.