Although the J-shaped association between alcohol consumption and blood pressure (BP) is well known, the effect of alcohol sensitivity on this relationship is less clear. We studied the association of alcohol sensitivity and alcohol use with BP and hypertension. This cross-sectional analysis included 19 335 older participants from the Guangzhou Biobank Cohort Study recruited from 2003 to 2006, using clinically measured BP and self-reported alcohol use and alcohol sensitivity. Alcohol use was rare in women, in whom light-to-moderate drinkers (<140 g ethanol per week) without alcohol sensitivity had lower systolic and diastolic BPs (mean difference 5.3 (95% CI 3.8-6.9) mm Hg and 1.9 (1.1-2.7) mm Hg, respectively) and a reduced risk of hypertension (0.62 (0.53-0.72)) relative to never drinkers. Similarly, excessive drinkers (>or=140 g ethanol per week) without alcohol sensitivity had a significantly higher systolic and diastolic BP and risk of hypertension than did nondrinkers (mean difference 5.1 (2.8-7.4) mm Hg, 2.7 (1.5-4.0) mm Hg and 34% (8-66%), respectively, for men). These differences were even greater for men with alcohol sensitivity (mean differences 12.0 (8.9-15.2) mm Hg, 6.2 (4.5-7.9) mm Hg and 95% CI (46-159%), respectively). Alcohol sensitivity and alcohol use were both associated with elevated BP and risk of hypertension in an older Chinese population. Alcohol sensitivity may aggravate the effect of drinking on BP. Limiting alcohol use to two drinks per day for men and one drink a day for women may be suitable for East Asians. Reduction of alcohol consumption should be an important public health target.