Objective: To investigate ghrelin level change in combination with psychological stress in the hypertensive old people with cognitive impairment and to explore its effect as well as possible mechanism. Methods: The study population of 300 elders was divided into 2 groups, 148 with hypertension and 152 non-hypertension, who were screened for psychological distress and cognition function, and had blood drawn to measure plasma levels of ghrelin and total cortisol on the same day. Results: The rates of anxiety and cognitive impairment were higher in the hypertension elders, which were negatively correlated with plasma ghrelin level, resulted from chronic cortisol response to anxiety. Conclusion: Chronic plasma cortisol increase to long-term anxiety leads a reduce in ghrelin level which then adversely affects blood pressure and cognitive function in old people. So measuring ghrelin of elders may be a diagnostic tool to predict cognitive development and ghrelin may be a selective antihypertensive medicine for cognitive impairment elders with or without chronic psychological stress.