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Background Genetic factors play an important role in susceptibility to hypertension. Herein, the association between acetaldehyde dehydrogenase 2 (ALDH2) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and hypertension was analyzed among Hakka population in southern China. Methods A total of 3057 hypertensive patients and 2215 controls were enrolled. The  ALDH2  rs671 and  MTHFR  rs1801133 genotyping were analyzed using gene chip. Relevant information and medical records of these subjects were collected. Results Hypertensive patients with  ALDH2  rs671 G/A heterozygous had lower systolic blood pressure (SBP) than other genotypes ( P  &lt; 0.001), while hypertensive patients with A allele had lower diastolic blood pressure (DBP) than patients with G allele ( P  &lt; 0.001). The level of plasma homocysteine (Hcy) in patients with  MTHFR  CC, CT and TT genotypes showed an increasing trend ( P  &lt; 0.001). The  ALDH2  G/A genotype in the co-dominant model (adjusted OR 1.251, 95% CI 1.024–1.528,  P  = 0.028) and  ALDH2  A/A genotype in the recessive model (adjusted OR 1.221, 95% CI 1.008–1.478,  P  = 0.041) were significant risk factors for the presence of hypertension. The  MTHFR  C/T genotype in the co-dominant model (adjusted OR 1.307, 95% CI 1.039–1.643,  P  = 0.022) and  MTHFR  C/T and T/T genotypes in the dominant model (adjusted OR 1.281, 95% CI 1.146–1.430,  P  &lt; 0.001) were significant risk factors for the presence of hypertension. Further, logistic regression analysis showed that age, smoking, alcohol consumption, hyperhomocysteinemia, and high level of serum TG, Apo-A1, Apo-B were significant risks for hypertension. Conclusions In summary,  ALDH2  rs671 G/A, A/A genotypes and  MTHFR  rs1801133 C/T, T/T genotypes may be risk factors for hypertension in this Chinese Hakka population.

Association of ALDH2 rs671 and MTHFR rs1801133 polymorphisms with hypertension among Hakka people in Southern China