Objective To investigate the effect of cardiac rehabilitation exercise combined with health guidance in patients with hypertensive heart failure. Methods A total of 90 patients with hypertensive heart failure who were admitted to our hospital from February 2019 to February 2021 were enrolled and divided into control group and observation group using a random number table, with 45 patients in each group. The patients in the control group were given health guidancealone, and those in the observation group were given cardiac rehabilitation exercise combined with health guidance. The two groups were compared in terms of health behavior, cardiac function parameters, and activities of daily living. Results There was no significant difference in health behavior score between the two groups before and after intervention (P>0.05). Before intervention, there were no significant differences in cardiac function parameters between the two groups (P>0.05), and after intervention, compared with the control group, the observation group had asignificantly longerdistance in six-minute walk test (P<0.05), a significantly higher left ventricular ejection fraction (P<0.05), and significantly smallerleftatrial diameter, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter (P<0.05). Before intervention, there were no significant differences in the scores of Activities of Daily Living between the two groups (P>0.05), and after intervention, the observation group had significantly lower scores than the control group(P<0.05). Conclusion Cardiac rehabilitation exercise combined with health guidance can improve the health behavior and activities of daily living of patients with hypertensive heart failure and promote the recovery of cardiac function.