Objective: To investigate the effectiveness of peer education interventions in health management for elderly hypertensive patients, providing evidence for enhancing self-management capabilities, improving blood pressure control, and promoting long-term behavioral change. Methods: A total of 82 elderly hypertensive patients admitted to a tertiary hospital in Shanxi Province in March 2024 were selected, with 41 patients in each of the control and observation groups. The control group received routine health management, while the observation group additionally underwent peer education intervention. Changes in blood pressure levels, scores on the Hypertension Self-Management Scale, and medication adherence were compared between groups before and after intervention. Results: Post-intervention, the observation group exhibited greater reductions in systolic and diastolic blood pressure compared to pre-intervention levels than the control group (p < 0.05). Scores on the Hypertension Self-Management Scale dimensions, diet management, medication management, emotional management, condition monitoring, work and rest management, along with the total score, improved significantly compared to pre-intervention levels and were superior to the control group (p < 0.05). However, improvement in the exercise management dimension was not significant. Post-intervention, the medication adherence scores in the intervention group were also higher than those in the control group (p < 0.05). Conclusion: Peer education intervention can effectively promote blood pressure improvement in elderly hypertensive patients, enhance self-health management capabilities and medication adherence, and is suitable as an important supplement to community and hospital-based continuing care models.