Hypertension causes left ventricular hypertrophy and increases in large artery stiffness with ageing, both of which are cardiovascular risks. We studied cardiovascular remodeling in elderly hypertensive patients by measuring blood brain natriuretic peptide (BNP), left ventricular mass indices (LVMI), pulse wave velocities (PWV), and ambulatory blood pressures. We focused on ageing and sex-differences. Both LVMI and PWV correlated significantly with nocturnal blood pressures, which in turn correlated with BNP levels. Thus, BNP might be a candidate for a surrogate endpoint of target organ damage in elderly cases of hypertension. Left ventricular hypertrophy progressed with ageing more in women. Systolic blood pressures in women were shown to rise abruptly after menopause and to surpass those in men. However, more non-dippers were observed in men, suggesting that the absolute value of nocturnal blood pressure is a determinant of left ventricular hypertrophy. PWV accelerated with ageing, but it did not correlate with LVMI, suggesting that progression of cardiac remodeling with ageing was relatively independent of vascular remodeling. Finally, the greater mortality in elderly women might be associated with progressive left ventricular hypertrophy.