Until now, it has been challenging to examine what are the causes of the cognitive decline associated with hypertension and to understand the predictive variables that indicate the development of cognitive impairment in people with hypertension. This work is aimed to understand the interplay between heart rate variability and blood pressure and whether their combination can predict cognitive performance. This cross-sectional observational study involved patients with fifty-two adults with essential hypertension and a control group of 41 healthy adults without hypertension. Except for the diagnosis of hypertension the same inclusion criteria were adopted to balance the groups. The overall sample was divided based on HRV metrics. A complete neuropsychological battery was administered and resting heart rate variability in individuals with and without hypertension was measured. Hypertensive patients with altered HRV had worse cognitive performance, particularly in the executive domain. Low HRV and hypertension have interdependent and combined association with cognitive impairment. Our results indicate that the association between hypertension and cognitive performance is affected by HRV. For neuroscientists, it's time to look beyond the brain. And clinicians who treat the body can't assume that the brain is above involvement.