Abstract: Objective To explore the relationship between orthostatic hypotension（OH）and cognitive impairment in hypertensive patients. Methods A total of 175 primary hypertension patients with mean age of 65.6years（range:50to 80years）and without a history of stroke or leukoencephalopathy diagnosed with brain magnetic resonance imaging（MRI）were enrolled. Eighty-seven patients were male（49.7%）and 80.0% of patients underwent more than a middle school education. The blood pressure on both supine and standing position were measured.OH was defined as a decreased in systolic blood pressure（SBP）≥20 mm Hg and/or decreased in diastolic blood pressure（DBP）≥10mm Hg within 3minutes after standing up. The mini mental state scale（MMSE）was used to evaluate cognitive function.The criteria of cognitive impairment was defined as the MMSE score≤17points for illiterate,≤20points for primary school graduates and ≤24points for middle school education and above. The relationship between OH and cognitive impairment was analysed. Results Forty-four patients had cognitive impairment,the prevalence of cognitive impairment was 25.1%. There were 40 patients who met OH criteria（22.8%）.The incidence of cognitive impairment in OH group was significantly higher than that in non-OH group（47.5% vs18.5%,P=0.001）. The MMSE score was lower in OH group than that in non-OH group（23.68±3.37vs25.95±2.93,P =0.001）. The MMSE score was negatively correlated with SBP decline after standing up（r=-0.211,P=0.015）. Univariate and Mutivariable analyses showed that the factors associated with cognitive impairment included age,education and OH OR（95% CI）was 1.08（1.03-1.13）,0.89（0.81-0.99）and 3.56（1.61-7.90）respectively,all P＜0.05. Conclusion OH may be an independent risk factor for cognitive impairment in hypertensive patients.