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Few epidemiological studies have examined the association between serum aminotransferase levels and hypertension, and have yielded inconsistent results.A cross-sectional study was performed in a Chinese rural elderly population. A total of 2174 participants with normal range of aminotransferase levels and without excessive drinking were included in the present study. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured on fasting morning serum samples using the Kinetic method. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or receiving treatment for hypertension. Multiple logistic regression was used to estimate the association between gender-specific aminotransferase levels and hypertension.Increased serum ALT but not AST level was positively associated with hypertension. After adjusting for potential confounding variables, the association of hypertension and ALT level was only significant in women: for each 1 IU/L elevation of ALT level, the adjusted odds ratio (OR), and corresponding 95% confidence interval (CI) of hypertension was 1.04 (1.01, 1.07); the ORs of hypertension increased across tertiles of ALT, and the ORs (95% CIs) were 1.00, 1.17 (0.85, 1.60), and 1.63 (1.15, 2.31 (P value for trend = .021). Furthermore, the association was only significant in central obesity women or nondrinking women.ALT level was significantly associated with hypertension only in women in a Chinese rural elderly population. Further studies are warranted to explore the possible gender-related association and to extend them to different populations.