Objective  To investigate the status and influencing factors of safe drug use among oldest-old community residents with hypertension in Tangshan city of Hebei province, and to provide evidences for improving health management among elderly hypertension patients in communities.

  Methods  Using random cluster sampling, we recruited 1 882 hypertensives aged ≥ 75 years at community health care centers covered by a secondary and a tertiary hospital in Tangshan city; we then carried out a household survey among the oldest-old hypertension patients with a questionnaire on safe drug use from July 2016 to January 2017.

  Results  The mean scores of safe medication behavior for the 1 853 respondents with complete information was 30.17 ± 4.72 in the scale with a maximum score of 40 for the highest level of safe drug use. Multivariate regression analysis demonstrated following significant influencing factors for safe drug use among the respondents: education (β = 2.487), perceived happiness in life (β = – 5.833), attitude toward life and death (β = 1.667), frequency of participation in community activities (β = – 3.856), frequency of neighborhood communication (β = – 4.808), communication with children (β = – 2.044), frequency of contacting with friends (β = – 2.876), talking with people (β = – 1.480), attitude toward development of the elderly care (β = – 1.633), and medical burden (β = – 1.886) (all P < 0.05).

  Conclusion  Community health care workers should make efforts to promote attitude and behaviors about safe drug use among elderly hypertension patients.