Noise exposure and hypertension are associated with hearing loss. Occupational noise exposure for more than 10 years may increase the risk of hearing loss by 29%. Occupational noise exposure for more than 10 years and hypertension may increase the risk of hearing loss by 55%. Background: Combined effect of elevated blood pressure and occupational noise exposure on hearing loss have rarely been evaluated among Chinese population. Methods: This cross-sectional study was conducted in 242,811 participants. Logistic regression model was performed to estimate the independent and combined associations. Results: Compared with participants without occupational noise exposure, the risk of bilateral high-frequency hearing loss (BHFHL) was significantly higher for noise exposure 10 years or more (odds ratio [OR] = 1.29, 95% confidence interval [95% CI] = 1.23–1.35). Compared with no hypertension, participants with grade 1 hypertension had higher risk of BHFHL in all age groups (OR, 1.14; 95% CI, 1.09–1.20). As to the combined effect, the highest BHFHL risk was found in males (OR, 1.51; 95% CI, 1.37–1.67), especially among participants with grade 1 hypertension older than 50 years (OR, 1.65; 95% CI, 1.46–1.88). Conclusions: Elevated blood pressure may synergistically influence hearing loss combined with occupational noise exposure. [ABSTRACT FROM AUTHOR]