Objective To understand the differences in the incidence of hypertensive kidney damage between rural and urban areas, and analyze the effects of regular medication, reasonable diet, and reasonable exercise on blood pressure control and the incidence of hypertensive kidney damage. Methods A random sampling method was used to conduct a questionnaire survey and urine microalbumin testing on 391 residents aged 60 and above in Bo’ai, Jiaozuo, Henan Province. Single factor analysis of variance to understand the differences in various influencing factors between urban and rural areas; Using ordered logistic regression analysis to explore the factors influencing blood pressure control and hypertensive kidney damage. Results The incidence of hypertensive kidney damage among rural residents was 37% (80/216), while the incidence of hypertensive kidney damage among urban residents was 18.9% (33/175). The rural group patients had lower levels of regular medication, blood pressure control, reasonable diet, and reasonable exercise compared to the urban group patients, and the differences were statistically significant (P＜0.05). There was a negative correlation between various influencing factors and the incidence of hypertensive kidney damage. The regular medication, reasonable diet, and reasonable exercise of patients in the urban group had a more significant impact on blood pressure control than those in the rural group (P＜0.05). Regular medication, reasonable exercise, and reasonable diet were p;ositively correlated with blood pressure control (P＜0.05)， which were protective factors for blood pressure control. Regular medication, blood pressure control, reasonable diet, and reasonable exercise were negatively correlated with the prevalence of hypertensive kidney damage (P＜0.01)， and they were all protective factors for hypertensive didney damage. Conclusion There is a significant difference in the incidence of hypertensive kidney damage between urban and rural residents. Regular medication, reasonable diet, reasonable exercise, and blood pressure control are all significantly correlated with the incidence of hypertensive kidney damage and are all protective factors for hypertensive kidney damage