The relationship between vascular health--including flow-mediated dilation (FMD) and intima medial thickness (IMT)--and neurocognitive performance was examined in a sample of 124 sedentary, middle-aged adults with high blood pressure (systolic blood pressure, SBP, 130-159 mmHg or diastolic blood pressure, DBP, 85-99 mmHg) who were overweight or obese (body mass index 25.0-39.99 kg/m²). Patients completed a neuropsychological test battery, including measures of executive function and psychomotor speed, and measures of IMT and FMD were obtained. Hierarchical multiple regression analyses were used to investigate the association between vascular measures and neurocognitive performance after controlling for demographic factors and cerebrovascular risk factors. Higher levels of FMD predicted better executive function (b = 0.90, p = .045). Greater IMT tended to be associated with slower psychomotor speed (b = -0.82, p = .084), with the effect attenuated after controlling for FMD. Impaired FMD is associated with worse neurocognitive functioning among overweight adults with high blood pressure.