Alcohol consumption is an important environmental factor in the development of essential hypertension (EH) and cardiovascular disease. Several epidemiological studies have investigated the association between hypertension and acetaldehyde dehydrogenase 2 (ALDH2) genotype, although the results are inconsistent. The aim of the present study was to evaluate the possible effect of drinking behavior on the ALDH2-EH relationship in a Chinese Han population. A total of 1098 unrelated individuals with EH and 1021 controls of Chinese Han ethnicity were included. We evaluated the effect of three tag single-nucleotide polymorphisms on blood pressure (BP) and serum lipid level by blood chemical assays. The major findings were that rs671 guanine/adenine genotype (odds ratio (OR)=0.45, 95% confidence interval (CI): 0.28-0.74) and A allele (OR=0.55, 95% CI: 0.36-0.85) were associated with a decreased risk of EH in drinkers. In addition, the rs671 genotype influenced BP, triglyceride (TG) level and high-density lipoprotein cholesterol (HDL-C) level in the same drinking-dependent pattern. Drinkers who carried the A allele displayed lower systolic BP (β=-0.16, P=0.001) and TG level (β=-0.14, P=0.004) and higher HDL-C level (β=0.11, P=0.019), but this association was not observed in nondrinkers. In summary, we present evidence for the association of rs671 in the ALDH2 gene with susceptibility to EH, increase in BP and disturbance of serum lipid profiles in drinkers, but not in nondrinkers. Further functional research is warranted to elucidate the role of rs671 in the variation of BP and lipid levels in EH.