This study applied a cross-sectional, descriptive correlational design. The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. This study used a convenience sample of 137 women aged ≥50years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.