Objective To investigate the relationship between D-dimer/fibrinogen， triglycerides/highdensity lipoprotein， and blood pressure variability and cognitive impairment in patients with acute cerebral infarction and hypertension. Methods From September 2023 to June 2024， 100 patients with acute cerebral infarction and hypertension admitted to Beijing Shunyi Hospital were selected as the study group. According to the Montreal Cognitive Assessment（ MoCA） score， the patients were divided into cognitive impairment group （MoCA score＜26， n=48） and non-cognitive impairment group（ MoCA score 26 to 30， n=52）. Acute cerebral infarction patients（ n=100） admitted to our hospital during the same period were selected as the control group. Data were collected from two groups regarding age， gender， body mass index， infarct site， infarct volume， educational level， National Institutes of Health Stroke Scale（ NIHSS） score， total cholesterol， triglycerides， low-density lipoprotein， high-density lipoprotein， D-dimer， and fibrinogen. Pearson correlation was used to examine the relationship between D-dimer/fibrinogen， triglycerides/high-density lipoprotein， and blood pressure variability in patients. Logistic regression was employed to analyze factors influencing cognitive impairment in patients with acute cerebral infarction and hypertension. Receiver operating characteristic（ ROC） curves were used to analyze the value of D-dimer/fibrinogen and triglycerides/high-density lipoprotein in assessing cognitive impairment among patients with acute cerebral infarction and hypertension. Results There were statistically significant differences between study group and control group in terms of D-dimer［ （0.48±0.09） mg/L vs.（ 0.41±0.06）mg/L］， fibrinogen［ （3.46±0.51）g/L vs.（ 2.89±0.40）g/L］， triglycerides［ （1.76±0.32） mmol/L vs. （1.38±0.24） mmol/L］， and D-dimer/fibrinogen［ （16.43±3.51）×10-5 vs.（ 13.24±2.76）×10-5］， triglycerides/ high-density lipoprotein［ （1.65±0.47） vs.（ 1.13±0.33）］， 24-hour systolic coefficient of variation（ SCV） ［（12.54±2.97）% vs.（ 10.12±2.20）%］， and 24-hour diastolic coefficient of variation（ DCV）［ （15.09±3.16）% vs. （11.44±2.20）%］（ t=6.472，8.794，9.500，7.144，9.055，6.548，8.805； all P＜0.001）. Pearson correlation analysis revealed that D-dimer/fibrinogen and triglycerides/high-density lipoprotein were both positively correlated with 24-hour SCV and 24-hour DCV（ r=0.542， 0.424， 0.562，0.396； all P ＜ 0.001）. There were statistically significant differences between cognitive impairment group and non-cognitive impairment group in terms of D-dimer［ （0.52±0.11） mg/L vs.（ 0.44±0.07） mg/L］， fibrinogen［ （3.57±0.55） g/L vs.（ 3.36±0.47） g/L］， triglycerides［ （1.85±0.34） mmol/L vs.（ 1.68±0.30） mmol/L］， D-dimer/fibrinogen［ （18.23±3.91） × 10-5 vs. （14.77±3.14）×10-5］， triglycerides/high-density lipoprotein［ （1.87±0.51） vs.（ 1.45±0.43）］， 24-hour SCV ［（13.68±3.22）% vs.（ 11.49±2.74）%］and 24-hour DCV［ （16.29±3.43）% vs.（ 13.98±2.91）%］（t=4.373， 2.057，2.656，4.897，4.464，3.672，3.641； all P ＜ 0.05）. Logistic regression analysis showed that D-dimer/ fibrinogen［ OR=1.874， 95%CI（ 1.230，2.856）］， triglycerides/high-density lipoprotein［ OR=1.756， 95%CI （1.093， 2.822）］， and 24-hour SCV［ OR=1.715， 95%CI（ 1.038，2.833）］were factors affecting cognitive impairment in patients， and the differences were statistically significant（ all P ＜ 0.05）. The combined area under the curve（ AUC） for D-dimer/fibrinogen and triglycerides/high-density lipoprotein in predicting cognitive impairment was 0.901， superior to either single test， and the differences were statistically significant （ZD-dimer/fibrinogen-combined=3.080， P=0.002； Ztriglycerides/high-density lipoprotein-combined=3.223， P=0.001）. Conclusions Ddimer/ fibrinogen， triglycerides/ high-density lipoprotein are positively correlated with blood pressure variability in patients with acute cerebral infarction and hypertension. Furthermore， elevated levels of these biomarkers were identified as significant risk factors for cognitive impairment.