Abstract: Objective To understand the detection rates of hypertension and abnormal electrocardiogram among the noise-exposed population in Songjiang District of Shanghai City, and to analyze the influencing factors for hypertension and abnormal electrocardiogram. Methods Occupational health examination data, encompassing basic demographic information, physical examinations, audiometric testing, blood pressure measurements, and electrocardiogram (ECG) assessments, were collected from 20,165 noise-exposed workers across all manufacturing industries in Songjiang District in 2024.. Hypertension and abnormal ECG findings were designated as indicators of health impairment. Categorical data were presented as frequencies and percentages (%). Univariate chi-square tests and multivariate logistic regression analyses were employed to identify factors associated with hypertension and abnormal ECG outcomes. Results The detection rates of hypertension and abnormal electrocardiogram among noise-exposed workers in the manufacturing industry in Songjiang District were 22.78% and 13.06% respectively. Among different scales, industry categories and economic types, micro enterprises (26.90%, 25.29%), furniture manufacturing enterprises (31.01%, 31.28%) and domestic-funded enterprises (23.43%, 15.57%) had the highest detection rates of hypertension and abnormal electrocardiogram. The detection rates of hypertension and abnormal electrocardiogram were relatively high among male workers, those aged ≥60 years old and those with a Body Mass Index(BMI) ≥24 kg·m^-2. The detection rates of hypertension and abnormal electrocardiogram in workers exposed to noise combined with other hazards such as heat stress (27.47%, 16.87%) and benzene(22.22%, 23.46%) were higher than those exposed to noise alone (21.40%, 11.60%) (P<0.01). Compared to workers in the general equipment manufacturing industry, those in the automotive manufacturing industry had a higher risk of hypertension (OR=1.284, 95%CI 1.098-1.501), and those in the furniture manufacturing industry had a higher risk of abnormal electrocardiogram (OR=2.615, 95%CI 2.014-3.385). Male gender, BMI ≥24 kg·m^-2 and advanced age had potential associations with hypertension and abnormal electrocardiogram. In addition, compared to the group exposed to noise alone, the group with noise and other physical factors had a higher risk of hypertension (OR=1.146, 95%CI 1.071-1.288) and abnormal electrocardiogram (OR=1.179, 95%CI 1.072-1.297). Compared to the normal group, the risks of hyperemia and abnormal electrocardiogram in workers with abnormal high-frequency hearing threshold in both ears increased by 21.5% (OR=1.215, 95%CI 1.082-1.364) and 21.0% (OR=1.210, 95%CI 1.006-1.410), respectively. Conclusion Different types of employers (economic type, industry category, enterprise scale) and individual characteristics of workers (gender, age, length of service, BMI, exposure to other physical factors, and abnormal high-frequency hearing threshold in both ears) impacted the association between noise exposure and hypertension/electrocardiogram abnormalities. Employers should enhance the management of occupational noise. Besides focusing on hearing system damage, they should also pay attention to abnormal changes in blood pressure and electrocardiogram of workers, and take corresponding intervention measures to reduce the occurrence and development of cardiovascular diseases among workers exposed to noise.