Aim To study the relationship between H-type hypertension and cognitive impairment in elderly patients. Methods 150 elderly essential hypertension patients were selected from the Department of Gerontology and Geriatrics of the First Affiliated Hospital of China Medical University between August 2011 and February 2013. According to the plasmatic homocysteine （Hcy） levels the elderly essential hypertension patients were divided into 3 groups （none H-type hypertension group: Hcy＜10 μmol/L 40 patients H-type hypertension group 1:10 μmol/L≤Hcy＜20 μmol/L 60 patients H-type hypertension group 2: Hcy≥20 μmol/L 50 patients）. The mini-mental state examination （MMSE），Montreal cognitive assessment （MoCA） and the activities of daily living （ADL） were used to evaluate the cognitive function. According to the MMSE score and ADL score，the H-type hypertension patients were divided into 3 groups （control group，22 patients mild cognitive impairment （MCI） group，54 patients cognitive impairment （CI） group，34 patients）.Results In comparison to none H-type hypertension group，fasting blood glucose （FBG），postprandial blood glucose （PBG），Hcy and uric acid （UA） levels increased significantly，and MMSE score and ADL score decreased significantly in H-type hypertension group 1 and H-type hypertension group 2. In comparison to H-type hypertension group 1，creatinine （Cr），PBG and Hcy levels increased significantly，and MMSE score and ADL score decreased significantly in H-type hypertension group 2. There is a negative correlation between the score of MoCA and plasmatic Hcy level in elderly H-type hypertension patients. Conclusion Elderly patients with H-type hypertension have higher risk for cognitive impairment，and higher plasma Hcy level，the more severe the cognition impaired.