〔Abstract〕 Objective To investigate the distribution and characteristics of traditional Chinese medicine physique in the elderly with hypertension combined with asthenia. Methods A total of 200 elderly patients (aged ≥ 60 years old) with hypertension who were included in Guangdong Hospital of Traditional Chinese Medicine from January 2021 to February 2023 were selected and grouped according to the score of Fried scale. All patients were divided into a non-asthenic group of hypertension (with 52 cases), a hypertension combined with pre-asthenic group (with 84 cases) and a hypertension combined with asthenic group (with 64 cases). The levels of serum C-reactive protein (CRP) and 25–hydroxyvitamin D [25-(OH)D] in the three groups were compared, and the correlation between hypertension combined with frailty and serum CRP and 25-(OH)D levels in the elderly was analyzed, and the distribution law of traditional Chinese medicine constitution in the elderly with hypertension combined with frailty was explored. Results The CRP level and age in the hypertension preasthenia group and the hypertension preasthenia group were higher than those in the non-asthenia group (P < 0.05), and the 25-(OH)D level in the hypertension preasthenia group and the hypertension asthenia group was lower than that in the non-asthenia group (P < 0.05). Logistic regression analysis showed that age, CRP and 25-(OH)D were all risk factors for hypertension combined with fthenia in the elderly (P < 0.05). By linear correlation analysis, serum CRP was positively correlated with the degree of frailty in elderly patients with hypertension and frailty (r = 0.381, P < 0.05). Serum 25-(OH)D was negatively correlated with the degree of frailty (r = -0.420, P < 0.05). Among the 64 elderly patients with hypertension combined with asthenia, 11 cases had peace and quality (17.19 %). There were 53 cases of bias (82.81 %), the most of which were phlegm-dampness, 11 cases of Yin deficiency (17.19 %), 8 cases of Yang deficiency (12.50 %) and 5 cases of blood stasis (7.81 %). Conclusion CRP and 25-(OH)D levels have a certain predictive effect on senile hypertension combined with asthenia. Phlegm-dampness, Yin deficiency and Yang deficiency are the susceptible constitutions of senile hypertension combined with asthenia, which can be effectively prevented and treated by TCM constitutionology.