The association of antihypertensive medication use with cognitive decline (including mild cognitive impairment) or dementia (including Alzheimer's disease (AD), vascular dementia (VD) and any dementia) has still been an area of controversy. This study examined the association of antihypertensive medication use with cognitive decline or dementia using a quantitative meta-analysis of longitudinal studies. EMBASE and MEDLINE were searched for articles published up to Feb 2011. All studies that examined the relationship between antihypertensive medication use and the incidence of dementia or cognitive decline were included. Pooled relative risk (RR) was calculated using fixed and random-effects models. Fourteen studies met our inclusion criteria for this meta-analysis. All subjects were without dementia or cognitive impairment at baseline. There were subjects with (32,658) and without (36,905) antihypertensive medication use. The quantitative meta-analysis showed that there was no significant difference in incidence of AD (RR: 0.90, 95% confidence interval (CI): 0.79–1.03), cognitive decline (RR: 0.97; 95% CI: 0.92–1.03) and cognitive impairment (RR: 0.97; 95% CI: 0.92–1.03). The quantitative meta-analysis showed that the subjects with antihypertensive medication use were lower incidence of VD (RR: 0.67, 95% CI: 0.52–0.87) and any dementia (RR: 0.87; 95% CI: 0.77–0.96) than those without. The quantitative meta-analysis showed that antihypertensive medication use could decrease risk of the development of VD and any dementia, but could not decrease that of AD, cognitive decline and cognitive impairment.