AIMS/BACKGROUND: Individuals affected with bradyarrhythmia and hypertension exhibit distinct clinical manifestations. Arrhythmia is commonly managed with an artificial cardiac pacemaker. This study aims to investigate the effects of left bundle branch pacing (LBBP) and right ventricular septal pacing (RVSP) on blood pressure and cardiac function in patients with bradyarrhythmia and hypertension. METHODS: This retrospective study included 1060 patients with bradyarrhythmia and hypertension who were treated in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2020 and December 2023. According to the placement of cardiac pacing leads, patients were divided into the LBBP group (N = 260) and the RVSP group (N = 800). Baseline clinical characteristics were recorded, and intergroup comparisons were performed for postoperative blood pressure, cardiac function indicators, pacing parameters, QRS duration, and incidence of postoperative adverse events. RESULTS: Postoperatively, the LBBP group demonstrated significantly lower systolic blood pressure (SBP) and pulse pressure (PP) compared to the RVSP group (both p < 0.05). Regarding the time × group interaction, the interaction was significant for PP and SBP (p < 0.05). Significant time effects were observed for left ventricular ejection fraction (LVEF), cardiac output (CO), and cardiac index (CI) in both groups (all p < 0.05), and the group effect was significant for CI (p < 0.05). Regarding ventricular pacing percentage, both groups showed a significant decrease over time (p < 0.05); the LBBP group exhibited a slightly lower percentage than the RVSP group (p < 0.05), with a significant time × group interaction (p < 0.05). Similarly, threshold decreased over time (p < 0.05), while perception and impedance remained stable (p > 0.05). The paced QRS duration was significantly narrower with LBBP during the follow-up period (p < 0.05). Additionally, no significant differences were observed in the incidence of adverse events between the two groups, indicating comparable safety profiles (p > 0.05). CONCLUSION: In patients with bradyarrhythmia and hypertension, LBBP offers significant therapeutic benefits in reducing SBP, pulse pressure, and QRS duration, while maintaining safety profiles and stable pacing parameters.