The association between systolic blood pressure (SBP) and cognitive function is controversial in elderly adults. In addition, few studies focused on the cumulative effect of SBP. We aimed to investigate the association between cumulative SBP exposure and cognitive function among middle-aged and elderly adults.The analysis was based on the Asymptomatic Polyvascular Abnormalities Community (APAC) study. The primary predictor was the cumulative SBP calculated by consecutive SBP values measured through baseline (2006-2007) up to the fourth examination (2012-2013). The cognitive function was estimated by mini-mental state examination (MMSE) in the fourth examination. Linear regression and logistic regression analyses were used to investigate the association between cumulative SBP and cognitive function.Among 2211 participants (41.4% female, aged 40-94 years), 167 (7.55%) were diagnosed with cognitive impairment (MMSE score < 24). Higher cumulative exposure to SBP (per SD increment) was independently associated with poor cognitive performance after controlling for multiple factors (P < 0.001). We observed nondifferential association between men and women. However, higher cumulative SBP in the adults aged ≥60 years had a stronger association with poor cognitive performance compared with that in adults aged 40 to 60 years.Greater exposure to cumulative SBP is associated with worse cognitive performance among middle-aged and elderly adults. This association is similar between men and women, but stronger in elderly adults.