Abstract: Intestinal flora imbalance existed in patients with hypertension and cognitive impairment. Intestinal flora affected human blood pressure level, brain function, host behavior and might be related to hypertension with cognitive impairment. Regulation of intestinal flora with Chinese herbs such as tonifying liver and kidney, tranquilizing liver and suppressing Yang, promoting blood circulation and removing blood stasis had great advantages in preventing and treating hypertension with cognitive impairment. This paper reviewed the relationship among intestinal flora, hypertension and cognitive impairment, and the research status of TCM regulating intestinal flora in the treatment of hypertension with cognitive impairment, aiming to explore novel targets and ideas for preventing and treating hypertension with cognitive impairment.