Objective: to evaluate the antihypertensive effect and quality of life of elderly hypertension with Yin dificiency and Yang excess syndrome treated with Zishen Zhengan decoction and western medicine. Methods: 150 elderly patients diagnosed hypertension with Yin dificiency and Yang excess syndrome from January 2016 to January 2017 were randomly divided into two groups, with 75 patients in each group. The control group was treated with western medicine and the observation group was treated with the Zishen Zhengan decoction and western medicine. Adverse effects, blood pressure and the score of life quality was recorded after 2 months treatment. The peripheral blood of patients with hypertension was collected and the expression of miR-128 was detected using fluorescence reverse transcription?quantitative polymerase chain reaction (RT?qPCR). Results: the incidence of adverse reactions in the two groups had no significant difference (P > 0.05). The ambulatory blood pressure had no difference in the two groups before treatment (P > 0.05). After treatment, the indexes of ambulatory blood pressure in the observation group were controled better than those in the control group (P < 0.05). The level of miR-128 was lower in observation group compared with control group (P < 0.05). Moreover, the scores of life quality in the observation group were higher than those in the control group (P < 0.05). Conclusion: the treatment of integrated Zishen Zhengan decoction and western medicine in the elderly with Yin dificiency and Yang excess hypertension had better antihypertensive effect and improved the quality of life with same safety compared with the treatment of only western medicine, and the effect may through regulating miR-128. This study confermed the advantage of integrated Chinese and western medicine which was worth to popularise in clinical treatment in the future.