Recently, it has been reported that hypertension causes not only cerebro-cardiovascular diseases, but also a decline of cognitive function in the elderly. However, it is not clear whether or not aging and hypertension have a latent effect on the cognitive-neurobehavioral and cardiac functions in healthy elderly whose scores of basic activities of daily living (ADL) are fully maintained. We evaluated the effect of aging and hypertension on cognitive-neurobehavioral and cardiac functions in 25 healthy community-dwelling elderly subjects (mean age: 69 y.o.) whose scores of basic ADL were fully maintained. Subjects were followed over a 5-year period, and the following examinations were performed before and after a 5-year follow-up: echocardiography, 24-hr ambulatory blood pressure monitoring (ABPM), and cognitive-neurobehavioral function test. Left ventricular mass index was significantly increased in the hypertensive (HT) subjects relative to the normotensive (NT) subjects over the 5 years (% change: 3% for HT vs. -0.8% for NT, p = 0.03). The number of non-dippers significantly increased over the 5 years in the HT group (initially: 20% [2/10] vs. follow-up: 58% [7/12], p = 0.04). Visuospatial cognitive performance scale scores for evaluation of higher cognitive-neurobehavioral functions significantly deteriorated in the HT subjects (initially; 2,344 +/- 110 vs. 2,380 +/- 102, ns, and follow-up: 2,149 +/- 181 vs. 2,356 +/- 159, p = 0.04). Hypertension contributes to the impairment of the cognitive-neurobehavioral function in the elderly by latently affecting the functions of multiple organs. This occurs even if basic ADL is maintained for 5 years. Therefore, it is important to control BP not only to prevent cardiovascular events, but also to preserve the neurobehavioral function.