Hypertension is the most prevalent cardiovascular disease, leading to pathophysiological changes in the brain and deterioration of cognitive function by affecting cerebral blood supply and oxygenation. Xinkeshu, a new-generation specific drug for treating coronary heart disease, hypertension, and psycho-cardiological diseases in modern medical research, exhibits antioxidant, myocardial protective, and left ventricular hypertrophy-improving effects in hypertensive patients. However, its impact on cognitive function in hypertensive patients remains unclear. This study included 100 patients first diagnosed with hypertension and initiating antihypertensive treatment at the hypertension outpatient clinic of Tianjin Chest Hospital. Patients were randomly divided into a monotherapy antihypertensive group and a combined Xinkeshu and antihypertensive treatment group (Xinkeshu 4 tablets tid combined with antihypertensive treatment), with 50 patients in each group, and followed up for 3 months. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, Logical Memory Test (LMT), and Auditory Verbal Learning Test (AVLT) on the day of enrollment and after 3 months of treatment. Results: After 3 months of antihypertensive treatment, all patients showed significant improvement in immediate recall and recognition tests. The combined treatment group demonstrated more significant improvements in MoCA scores, LMT-immediate recall, AVLT-immediate recall, and AVLT-short delay recall scores after 3 months of treatment, while improvements in LMT-delayed recall and AVLT-long delay recall were not significant. This suggests that antihypertensive treatment and combined treatment for 3 months can improve cognitive function by enhancing immediate recall in hypertensive patients. Discussion: Xinkeshu may improve cerebral blood supply and oxygenation through the combined effects of its five individual herbs and their separate pharmacological components, thereby improving cognitive function in hypertensive patients.