Objective The changes of right ventricular function in elderly patients with essential hypertension before and after antihypertensive treatment were evaluated by real-time three-dimensional echocardiography. Materials and Methods 97 cases of essential elderly hypertension were divided into left ventricular mass index (LVMI) normal group (50 cases) and LVMI increased group (47 cases) according to LVMI. All patients were treated with standardized antihypertensive therapy. Echocardiography was performed before and after treatment to compare changes in right ventricular function. Results After 24 months of treatment, the blood pressure of the two groups decreased significantly (P＜0.05). In normal LVMI group, PWTd, IVSd and LVMI decreased after antihypertensive treatment, while TAPSE increased after antihypertensive treatment, the difference of which was statistically significant (P＜0.05). In increased LVMI group, LVIDd, PWTd, IVSd, LVMI, E/E' , E/e’ and PASP decreased after antihypertensive treatment, while RVEF and TAPSE increased after antihypertensive treatment, the difference of which was statistically significant (P＜0.05). Conclusion Antihypertensive therapy can improve the right ventricular function in elderly patients with hypertension. RT-3DE has important clinical significance for the evaluation of clinical treatment effect and prognosis.