Abstract Background Malnutrition may negatively influence cardiovascular outcomes. We investigated the association between geriatric nutritional risk index (GNRI) and ambulatory blood pressure in elderly patients with hypertension. Methods Our study included 235 elderly hypertensive patients with malnutrition (GNRI ≤98)and 391 patients with normal nutrition (GNRI>98). All patients underwent ambulatory blood pressure monitoring and assessment of nutritional status including total protein, prealbumin and serum albumin. Results Patients with malnutrition, compared with normal nutrition, were older, had a significantly (p ≤ 0.05) higher serum creatinine, and lower body weight, estimated glomerular filtration rate, serum low density lipoprotein cholesterol, serum total protein, prealbumin, and albumin, body mass index and GNRI (p ≤ 0.01). After multivariable adjustment, malnourished patients had significantly higher 24-h, daytime and nighttime systolic blood pressure (p ≤ 0.001). Lower GNRI was independently associated with higher 24-h, daytime and nighttime systolic blood pressure after adjustment for confounding factors (p<0.05). Conclusions Elderly hypertensive patients with malnutrition had higher systolic blood pressure than those with normal nutrition. GNRI was associated with 24-h, daytime and nighttime systolic blood pressure.