In the study, men with high blood pressure who reported having about one or two drinks a day were 44 percent less likely to die of cardiovascular causes such as heart attacks than men with hypertension who rarely or never drank.
Alcohol is known to increase levels of good and can thin the blood, warding off artery-clogging clots that can cause heart attacks.
A drink or two a day has been linked with reduced cardiovascular risks in healthy men and women. But many doctors are wary about alcohol use among people with hypertension because heavy drinking can increase blood pressure. For that reason, the American Heart Association generally advises patients with high blood pressure to avoid alcohol.
The latest findings suggest that moderate alcohol consumption offers the same benefits to hypertensive patients as it does to healthy people. But the researchers said the findings need to be confirmed in other large-scale studies.
They and other experts advised people with high blood pressure to remain wary about drinking.
"In light of major clinical and public health problems associated with heavy drinking, recommendations regarding alcohol use must be made on an individual basis," said the authors, led by Dr. J. Michael Gaziano, a researcher at Brigham and Women's Hospital and the Veterans Affairs hospital in Boston.
The findings appear in Monday's Archives of Internal Medicine.
The study examined 14,125 male physicians who reported having current or past hypertension and were followed for an average of about five years. During the follow-up, 579 men died from cardiovascular causes, including heart attacks and strokes.
A reduced risk was found in men who drank moderately and who had blood pressure of at least 140 over 90, the cutoff for high blood pressure, or who kept their blood pressure down with medication or other means.
The data did not differentiate between beer, wine and liquor.
The authors suspect the results would also apply to women.
Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital, said the study could send "a very bad public health message" about alcohol. She said that people who drink might have other characteristics that reduce their heart risks.
"The recommendation to avoid alcohol is a wise one among patients with high blood pressure," said Mosca, an American Heart Association spokeswoman. "The benefit is not proven, and there are known risks."
By Lindsey Tanner