Abstract： Objective To observe the efficacy and heart rate variability in hypertensive patients by two med-icine durg treatment. Methods 60 cases of hypertensive patients were randomly divided into two groups bisoprolol group(n = 30) and perindopril group(n = 30). Treatment for four weeks, both before and after treatment, ambulatory blood pressure(ABPM) ,and heart rate variability were analyzed. Results Antihypertensive effect:A group of 30 pa-tients,markedly effective 9 cases(30.0%) ,effective 11 cases(36.7%) ,invalid in 10 cases(33. 3%) ,the total effi-ciency of 20 cases (66.7%); B group of 30 patients, 4 cases (13.3%) markedly effective, effective 8 cases(26.7%),invalid in 18 cases (60.0%), the total efficiency of 12 cases (40.0%), the total efficiency of the two groups had significant difference(X2 = 3.95, P < 0.05) ;two groups after treatment VLF, LF levels were significantly lower than before treatment(P < 0.05 or P < 0.01) ; A group of the total incidence of adverse reactions(3.1%) lower than in group B (10.0%) (X2 = 3.85,P < 0.05). Conclusion Bisoprolol can effectively lower blood pressure, heart rate and improve the heart rate variability in patients with hypertension, thereby preventing cardiovascular events in patients with hypertension.