Objective To investigate the current status and influencing factors of fall alertness in older hypertensive patients in rural areas, and to provide reference for the development of intervention programs to prevent falls. Methods A total of 443 older hypertensive patients in the western and northern rural areas of Hunan province were selected and investigated using the general information questionnaire, Self-awareness of Falls in Elderly Scale (SAFE), the Tilburg Frailty Indicator (TFI), and the Hypertension Self-Management Behavior Scale. Results The fall alertness score of older hypertensive patients in rural areas was (68.82±20.47), and the results of multiple linear stepwise regression analysis showed that age, sleep status, whether a fall occurring in the past year, participation in group activities, whether taking long-term medication, frailty,and self-management of hypertension were the influencing factors of fall alertness in older hypertensive patients in rural areas (all P<0.05). Conclusion Older hypertensive patients in rural areas have higher awareness of falls and lower degree of frailty. Community healthcare workers need to provide health education to rural older hypertensive patients according to the influencing factors,and improve their fall alertness to reduce the incidence of falls.