BACKGROUND: Unhealthy sleep behaviors are important risk factors for elevated blood pressure (BP), but evidence is limited for the combined effects of sleep behaviors on BP, especially among different ethnic groups at diverse altitudes. OBJECTIVES: We aimed to investigate the association between combined sleep behaviors and BP among multi-ethnic groups at varied altitudes in China. METHODS: The baseline survey of the Regional Ethnic Cohort Study in Northwest China enrolled more than 100,000 adults 35 to 74 years of age from multi-ethnic groups at varied altitudes in 5 provinces between 2018 and 2019. A healthy sleep score (HSS) was constructed considering 4 sleep behaviors (sleep duration, insomnia, snoring, and excessive daytime sleepiness). Multiple linear or logistic regression models were used to evaluate the associations of sleep factors with systolic BP, diastolic BP, mean arterial pressure, and hypertension. RESULTS: Among the 97,476 participants, 34,407 (35.3%) had an HSS of 4 and 6,934 (7.1%) had an HSS of 0-1. Compared with participants with an HSS of 0-1, those with an HSS of 4 had lower systolic BP (β: -4.19; 95% CI: -4.63 to -3.76), diastolic BP (β: -3.13; 95% CI: -3.40 to -2.85), and mean arterial pressure (β: -3.48; 95% CI: -3.78 to -3.18), and reduced odds of hypertension (OR: 0.68; 95% CI: 0.64-0.73). Each additional HSS was associated with 13% lower odds of hypertension (OR: 0.87; 95% CI: 0.86-0.89). The inverse associations appeared to be stronger among the Uygur ethnicity and at low residential altitude. CONCLUSIONS: Healthy sleep pattern may decrease BP among different ethnic groups at varied altitudes in Chinese adults.