Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. Objective: To assess whether alcohol consumption is inversely associated with CVD among men with hypertension. Design: Prospective cohort study. Setting: United States. Participants: 11 711 men with hypertension from the Health Professionals Follow-Up Study. Measurements: Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002. Results: During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00). Limitations: Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables. Conclusions: In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits. © 2007 American College of Physicians.