Although a light to moderate alcohol intake is associated with a lower risk of acute coronary syndrome (ACS), alcohol is also associated with risk of hypertension, which in turn is a strong risk factor of ACS. We examined whether middle-aged men and women with hypertension also benefit from a light to moderate alcohol intake in relation to risk of ACS and overall mortality. We used data from 57,053 men and women, aged 50-64, who participated in the Danish Diet, Cancer and Health study. Information on alcohol intake (amount and frequency) was reported by the participants. Hypertension status was assessed at baseline by combining blood pressure measurements and self-reports. During follow-up, 860 and 271 ACS events occurred among men and women. Irrespective of alcohol intake, participants with hypertension had a higher risk than participants with normal blood pressure. Alcohol intake was associated with a lower risk of ACS among participants both with and without hypertension and there was no evidence of interaction between alcohol intake and hypertension. Those who drank moderately had a lower mortality than abstainers and those who drank heavily; and for all levels of alcohol intake, participants with hypertension had a higher risk than participants with normal blood pressure. Results were similar for men and women. These findings indicate that a light to moderate alcohol intake has similar effects on the risk of ACS in men and women with and without hypertension.