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Objective To investigate the association between hot spring bathing behavior and hypertension and understand the mediation effect of sleep quality problems on the association. Methods A cross-sectional survey was conducted among adults aged 30 to 65 living and working around five hot springs in Guizhou Province, employing a self-designed questionnaire on the health status and hot spring bathing, and 3 708 qualified questionnaires were collected. Participants were divided into three groups according to their frequency of hot spring bathing never, occasionally, and frequently. Stratified via sex and sleep quality, the binary logistic regression model was used to analyze the association between different hot spring bathing frequencies and self-reported hypertension. Results Significant difference was detected in the self-reported hypertension between groups who never bathe(13.7%), who occasional bathe(9.4%)and who frequently bathe(8.5%)among female participants(χ2=10.460, P=0.005). However, no significant difference was found among different bathing groups in males. Furthermore, multivariate analysis showed that compared with no bathing, occasional(OR=0.692)and frequent (OR=0.594)hot spring bathing were associated with lower hypertension prevalence among female population, and female groups of occasional and frequent bathing with sleep quality problems had smaller OR(OR=0.571 and 0.406, respectively). After sleep quality problems were included, hot spring bathing was still associated with lower hypertension risk, and the OR values of occasional bathing and frequent bathing groups were 0.723 and 0.611, respectively. The sleep quality problems of female population played a partial mediating role in the association between hot spring bathing and hypertension, and the relative mediating effects of occasional bathing and frequent bathing with hypertension were both statistically significant(Zm=-2.022 and -1.995, P < 0.05), which accounted for 34.34% and 30.15% of the total effects, respectively. Conclusion Regular hot spring bathing may play an auxiliary role in the prevention of hypertension, and it may provide a stronger protection for women, and especially those with sleep quality problems. Sleep quality problems may explain part of the association between hot spring bathing and hypertension in female population.