This paper has adopted related meteorological data collected by 69 meteorological stations between 1951 and 2013 to analyze changes and drivers of reference evapotranspiration (ET0) in the hilly regions located in southern China. Results show that: (1) ET0 in southern China’s hilly regions reaches its maximum in summer and its minimum in winter, and that the annual ET0 shows an increasing trend. ET0 happened abrupt change due to the impact of abrupt meteorological variables changes, and the significant year of mutation were 1953, 1964 and 2008. Most abrupt changes of ET0 in meteorological stations occurred in the 1950s and 1960s. (2) The low value of ET0 was mainly captured in high-altitude areas. Spatially, the ET0 in the east was higher than that in the west. With the exception of a handful of stations, the trend coefficients of ET0 were all positive, exhibiting a gradual rise. Changes in ET0 in the east were much more sensitive than that in the west. Since ET0 was affected by the cyclical changes in relative humidity, short-period oscillations were observed in all these changes. (3) In general, the ET0 was negatively correlated with relative humidity, and positively correlated with temperature and sunshine percentage. ET0 is most sensitive to changes in average temperature, with a sensitivity coefficient of 1.136. ET0 showed positive sensitivity to average temperature and sunshine hours, which were notable in the northeastern, and uniform in the spatial. ET0 showed negatively sensitivity to relative humidity, and the absolute value of sensitivity coefficient in the northwestern is smaller. The highest contribution to ET0 is the average temperature (6.873%), and the total contribution of the four meteorological variables to the change of ET0 is 7.842%. The contribution of average temperature, relative humidity, and sunshine hours to ET0 is higher in the northern and eastern, northern, northern and eastern areas, respectively. Climate indexes (Western Pacific Index (WP), Southern Oscillation Index (SOI), Tropical Northern Atlantic Index (TNA), and El Niño-Southern Oscillation (ENSO)) were correlated with the ET0. In addition, the ET0 and altitude, as well as the latitude and longitude were also correlated with each other.