Abstract: Objective To investigate the association between cerebral vascular variation and hypertension in adults. Methods Using a cross-sectional study, the current and retired employees of Kailuan Group who participated in the physical examination of Kailuan General Hospital and underwent magnetic resonance imaging in 2020-2022 were taken as the observation objects, and a total of 1,029 participants were finally included. All partipants were divided into four groups: no cerebral vascular variation（217 cases, 21.1%）, only vertebral artery hypoplasia（VAH）（118 cases, 11.5%）, only incomplete posterior Circle of Willis（ipCoW）（482 cases, 46.8%）, and combined variations（VAH+ipCoW）（212 cases, 20.6%）. Binary logistic regression models were conducted to explore the effects of different types of cerebral vascular variation on hypertension. Results The mean age of the study population was（55.2±11.4）years.The prevalence of hypertension were 42.9%, 49.2%, 54.4%, and 70.8% in the no cerebrovascular variant group, the VAH-only group, the ipCoW-only group, and the combined variant group, respectively（χ~2=35.825, P＜0.001）. Hypertension was set as the dependent variable and cerebral vascular variation type was set as the independent variable, the results showed that the coexistence of VAH and ipCoW was positively associated with hypertension risk（OR=2.410, 95%CI 1.401-4.146） after adjusting for multiple confounders. Stratified analysis showed that the association was more significant in the population aged 55 years and younger（OR=4.437, 95%CI 1.891-10.406）, whereas no significant association was found in the population older than 55（P＞0.05）. Conclusion There is a positive association between cerebral vascular variation and hypertension, and this association is predominantly observed in the younger population.