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The association of blood pressure levels with the effects of alcohol intake on the vasculature has not been clarified. We evaluated the differential effects of alcohol intake on the vasculature of subjects with optimal or normal blood pressure (ONbp) and those with high normal blood pressure or higher (HNHbp) in a 6-year follow-up study. The pulse wave velocity (PWV) was measured on three occasions at an interval of 3 years in 1185 middle-aged Japanese men (age 41+/-8 years). In subjects with ONbp (n=677), a U-shaped relationship between alcohol intake (non-drinker, and light-to-moderate and heavy alcohol intake groups) and the increase in the adjusted value of PWV was observed at the end of 6 years' observation. On the other hand, in subjects with HNHbp (n=508), a U-shaped relationship was not observed. At the end of 6 years' observation, the increase in PWV was significantly more in the heavy intake group than in the light-to-moderate intake group or the non-drinker group, even after adjustment for changes in blood pressure and prescribed medication (P<0.01). In conclusion, blood pressure levels may modulate the effects of alcohol intake on the vasculature in middle-aged Japanese subjects. In subjects with ONbp, light-to-moderate alcohol intake appeared to have a possible vasculoprotective effect; on the other hand, in subjects with NHNbp, heavy alcohol intake seemed to exert a detrimental effect on the vasculature.