Objective To investigate the utilization and the factors influencing satisfaction of follow-up service among hypertension patients in western rural areas of China, and to provide evidences for strengthening the effect of follow-up management of hypertension in west of China. Methods Use the special survey data of township and village health services integration in western rural areas of China in 2014. 880 participants were examined with stratified random sampling method in Qinghai agricultural areas, Qinghai pastoral areas, Inner Mongolia and Xinjiang Uygur Autonomous Region. Pearson ?2 and Binary Logistic regression were used to analyze the data. Results 72.7% of the patients were followed up for more than 4 times a year. 88.3% of the patients had face to face follow-up service. 64.2% of the patients were informed of the next follow-up time. 61% of the patients believed it is necessary for follow-up regardless of the severity of the disease. These rates were statistically different in the above 4 areas (P<0.05). The Binary Logistic regression showed that district, distance from the nearest medical unit, times of follow-up service and whether to be informed of the next follow-up time were influencing factors. Conclusion Personalized follow-up should be provided in the rural areas of the West China, meanwhile strengthen the prevention and control of hypertension and its complications. It is also suggested that make innovations in the management of chronic disease and promote hypertension patients to participate in the follow-up.