Abstract: Objective To explore the clinical significance of monitoring the four indicators of urine test in elderly patients with essential hypertension with different grades and disease courses. Methods From June to December 2018, 263 elderly patients with essential hypertension were included in our hospital's outpatient department for routine urine examination. According to the classification of hypertension, the patients were divided into three groups:grade 1(94 cases), grade 2(102 cases) and grade 3(67 cases). To compare the levels of four commonly used indexes in urine test of elderly patients with hypertension in different grading groups, including 24 h urinary protein quantity, urinary microalbumin, urinary β2 microglobulin and N-acetyl-β-d-glucosaminidase. Results The comparison of urine test levels of elderly patients with essential hypertension in different hypertension grading groups(F=6.452, 36.750, 33.911 and 7.180) and different course groups(F=6.452, 36.750, 33.911 and 7.180) showed statistically significant differences(all P<0.05). The level of urine test in grade 2 group and grade 3 group was higher than that in grade 1 group(P<0.05). The grade 3 group was higher than the grade 2 group(P<0.05). The levels of the four indicators of urine test in the group with disease course of 10(including)-20 years and ≥ 20 years were higher than those in the group with disease course<10 years(all P<0.05). The course of disease ≥ 20 years was higher than that of 10-20 years(P<0.05). Conclusion The elderly patients with hypertension have different grades and course of hypertension. The higher the score of hypertension and the longer the course of hypertension, the higher the level of the four commonly used indexes and the more serious the condition. It is suggested that clinical attention should be paid to the monitoring of four indicators commonly used in urine test for elderly hypertensive patients with long course of disease and severe condition.