Abstract: Objective: To investigate the prodictive value （PV） of the heart ratevariability index （HRVI） for the cardiac accident （CA） in the elderly hypertensive patients.Methods: 231 hypertensive patients （≥60 years） were examined by Holter ECG and UCG to determine HRVI, left ventricular mass index （LVMI） and left ventricular ejection fraction （LVEF）. The PV of those parameters above for the CA was analyzed by Logistic multiple regression method after the period of two year follow up. Results: The incidence of decreased HRVI （≤25） and mean HRVI were 61.9% and 19.8±9.4 in LVH group （LVMI≥134 g/m² in male, ≥110 g/m² in female）; 29.5% and 22.4±7.1 in NLVH group （P＜0.05）;64.2% and 18.8±8.5 in LVEF＜50% group; 31.5% and 22.7±11.1 in LVEF≥50% group （P＜0.001）; 97.8% and 17.3±8.2 in CA group, 33.0% and 23.4±7.9 in NCA group （P＜0.001） respectively. The results of logistic analysis in these patients showed that the PV of HRVI was highest among those parameters （r=-0.6453, P=0.0001）,then were LVEF （r=-0.4983, P=0.0028）, LVMI （r=0.3879, P=0.0024） and age （r=0.2845, P=0.0001）. Conclusion: The decrease of HRVI as an independent risk factor has very important PV for CA in the elderly hypertensive patients.