OBJECTIVE:: Studies have shown that famine exposure during early life may increase the risk of cardiovascular disease (CVD), hypertension, and diabetes during adulthood. We aimed to assess whether exposure to the Chinese famine (1959–1961) modifies the association between hypertension and CVD. METHODS:: We investigated data of 5772 adults born between 1954 and 1964 from the China Health and Retirement Longitudinal Study. CVD was based on self-reported doctorʼs diagnosis of heart problems (heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems) and stroke. RESULTS:: Overall, hypertension was associated with a doubling of CVD risk (odds ratio 1.97, 1.56–2.48, P?<?0.001). There was a significant interaction between hypertension and famine exposure for CVD (P?=?0.04). The odds ratio of hypertension for CVD were: 1.69 [95% confidence interval (CI) 1.06–2.72, P?=?0.03], 2.35 (95%CI 1.44–3.83, P?=?0.001), 2.48 (95%CI 1.49–4.11, P?<?0.001), 3.35 (95%CI 1.54–7.27, P?=?0.002), and 1.40 (95%CI 0.82–2.38, P?=?0.215) among adults in late childhood, mid childhood, early childhood, fetal, and nonexposed cohorts, respectively. The risk gradient between hypertension and CVD across famine cohorts was mainly seen among women, those living in urban areas and those with central obesity. CONCLUSION:: Early life exposure to the Chinese famine exacerbated the association between hypertension and CVD, especially among women and those living in urban areas or those with central obesity.