AIM The aim of our observational research was to make an in-depth analysis of the autonomic function in normotension and hypertensive patients over 60 years old with coronary artery disease. Method 104 patients over 60 years old with coronary heart disease (CHD) were divided into normotension group and hypertension (HT) group. 24-hour Holter monitoring was carried out to assess the autonomic function. Result Among the 104 patients analyzed, 52 patients had coronary heart disease with normotension, and 52 had coronary heart disease with hypertension. The 24-Holter results of time-domain methods showed that values from time-domain parameters for heart rate variability (HRV) were significantly lower in coronary heart disease patients with hypertension than coronary heart disease group. Furthermore, both during the daytime and during the nighttime, the time-domain parameters were significantly lower in coronary heart disease patients with hypertension than coronary heart disease group. We found there was no difference in autonomic function during the daytime and during the nighttime in their own group. Values from frequency-domain parameters for HRV were also significantly lower in CHD patients with hypertension than CHD group. More patients in the CHD+HT group than in the CHD group received the percutaneous coronary intervention (57.69% vs. 50% c2=0.619, p=0.55). Through the 12 months of follow-up, we found no significant difference in rehospitalization for unstable angina and target lesion revascularization between CHD patients with normotension and CHD patients with hypertension. Conclusion The dysfunction of heart autonomic nervous in CHD patients over 60 years old with hypertension was more serious than CHD patients with normotension, and more clinical attention should be aroused.