**Background:** Hypertension is a major global public health challenge, with prevalence in China rising from 13.6% in 1991 to 27.9% in 2015. Prior research on tea consumption and blood pressure has yielded inconsistent findings, possibly due to limited sample sizes, population heterogeneity, and insufficient consideration of different tea types. Southwest China, with its diverse ethnic groups and wide variety of teas (green, dark, scented, sweet, and black tea), provides an ideal setting to investigate these associations.
**Methods:** This study analyzed baseline data from the China Multi-Ethnic Cohort (CMEC), which enrolled 99,556 participants aged 30–79 from five provinces in Southwest China between May 2018 and September 2019. After excluding those with physician-diagnosed hypertension, cardiovascular disease, or missing blood pressure measurements, 76,673 participants were included. Blood pressure was measured three times using an electronic sphygmomanometer following American Heart Association standards. Hypertensive BP was defined as average SBP ≥ 140 mmHg or average DBP ≥ 90 mmHg. Tea consumption was assessed via face-to-face interviews covering status, type, duration, frequency, and amount. Binary logistic regression was used to examine associations with hypertensive BP, and multiple linear regression was used for continuous SBP and DBP outcomes. Analyses were adjusted for age, sex, ethnicity, marital status, education, occupation, family income, BMI, physical activity, smoking, alcohol use, dietary factors, family history of hypertension, and physician-diagnosed diseases. Stratified analyses by age, sex, BMI, smoking, alcohol use, and salt intake were performed.
**Key Results:** Among 76,673 participants, 25,315 (33.01%) reported tea consumption. The prevalence of hypertensive BP was 19.07% (14,624 participants). Overall, tea consumption was associated with a 10% lower risk of hypertensive BP (AOR: 0.90, 95%CI: 0.86–0.94). By tea type, the risk reductions were: dark tea (AOR: 0.74, 95%CI: 0.66–0.83), sweet tea (AOR: 0.78, 95%CI: 0.66–0.91), black tea (AOR: 0.81, 95%CI: 0.65–1.00), scented tea (AOR: 0.91, 95%CI: 0.83–0.98), and green tea (AOR: 0.94, 95%CI: 0.89–0.99). For SBP, dark tea was associated with reductions of 1.79–5.31 mmHg across consumption patterns; sweet tea with 3.19–7.18 mmHg reductions; green tea with 1.21–2.98 mmHg reductions; scented tea with 1.26–2.48 mmHg reductions; and black tea with reductions up to 5.76 mmHg for long-duration drinkers. For DBP, dark tea showed modest reductions (0.47–1.02 mmHg), and scented tea reduced DBP by 0.84 mmHg (95%CI: -1.65 to -0.02) at low frequency (1–2 d/w). Green tea was associated with a slight DBP increase (≤ 0.7 mmHg) in certain consumption patterns. Stratified analyses showed the protective effect was stronger in women, non-smokers, non-drinkers, those with normal weight or overweight, and participants over 50 years old. High salt intake weakened the protective association.
**Clinical Implications:** This large population-based study provides evidence that tea consumption is associated with lower blood pressure and reduced risk of hypertensive BP, with effects varying by tea type and consumption habits. Dark tea demonstrated the strongest association with reduced hypertensive BP risk (26%) and was the only tea type consistently associated with both lower SBP and DBP. Sweet tea showed the largest SBP reductions (up to 7.18 mmHg), though it was paradoxically associated with slight DBP increases in some subgroups. These findings suggest that specific tea consumption recommendations could be tailored for blood pressure management, though the cross-sectional design precludes causal inference. The results support the potential role of tea polyphenols and other bioactive compounds in cardiovascular health, and highlight the need for randomized controlled trials to confirm these associations and establish causal relationships.