In mild hypertensive patients, regional cerebral blood flow, measured by positron emission tomography, was reduced in the frontal cortex and basal ganglia compared with normotensive patients. In moderate to severe hypertensive patients, cerebral oxygen metabolism was diminished, although the patients were neurologically intact. In elderly hypertensives, white matter vascular lesions on brain imaging were more frequent and cognitive function was impaired, compared with age-matched normotensives. In nontreated spontaneously hypertensive rats (SHR), local cerebral blood flow was decreased in the cortex and thalamus, compared with normotensive rats (NTR). Spatial memory and learning in maze tests were more impaired in aged SHR than in old NTR or young SHR. This inpairment was related to decreased cerebral glucose utilization in the medial septal nucleus, hippocampus, and other regions of the brain. Reduced cerebral blood flow, increased media thickness of the cerebral arteries and impaired cognitive function in SHR were improved by long-term antihypertensive treatment. In humans as well as animals, long-standing hypertension per se leads to reductions in cerebral blood flow, metabolism, and cognitive function, each of which possibly may be improved by controlling hypertension with long-term antihypertensive treatment. (Hypertens Res 1995; 18: 111-117)