We investigated associations of the Gly460Trp polymorphism of the alpha-adducin gene and concentrations of serum total bilirubin, serum direct bilirubin and serum unconjugated bilirubin in patients with essential hypertension from Anhui, China from September 2000 to January 2001. Compared to women with the Gly/Gly genotype and after adjustment for important covariates, women with the Trp/Trp genotype had lower mean concentrations of serum total bilirubin (beta = -1.2 micromol/L; P = 0.01), serum direct bilirubin (beta = - 0.4 micromol/L; P = 0.02) and serum unconjugated bilirubin (P = -0.8 micromol/L; P = 0.03). Among women in either the upper or lower quartiles of serum total bilirubin, serum direct bilirubin and serum unconjugated bilirubin and compared to those with the Gly/Gly genotype, women with the Trp/Trp genotype had higher odds of being in the lower quartile of concentrations of serum total bilirubin (odds ratio = 4.0; 95 percent confidence interval: 1.6 - 10.2; P < 0.01), serum direct bilirubin (odds ratio = 4.0; 95 percent confidence: 1.6 - 9.7; P < 0.01) and serum unconjugated bilirubin (odds ratio = 2.7; 95 percent confidence interval: 1.1 - 6.7; P = 0.03) after adjustment for important covariates. We did not observe any significant associations in these models for men. We concluded that the Trp/Trp genotype of alpha-adducin Gly460Trp was associated with lower serum bilirubin concentrations in this group of Chinese women with essential hypertension. Women with the Trp/Trp genotype of alpha-adducin Gly460Trp might have increased risk for cardiovascular diseases due to lower concentrations of serum bilirubin.