Abstract Introduction: This study examined the association between smoking and heart disease in workers with a medical history of hypertension. Methods: Data were obtained from the 2018 Indonesian Basic Health Research database. Information was collected from 80,602 respondents who met the inclusion criteria: workers between the ages of 15 and 64 years who were exposed to cigarettes and had a medical history of hypertension. Multivariate logistic regression analysis assessed the association between smoking behavior and heart disease in workers with hypertension. Results: A strong association was observed between passive smoking and heart disease. The odds of developing heart disease were significantly higher in passive smokers who were former cigarette smokers than passive smokers who never smoked a cigarette (adjusted odds ratio [aOR] = 2.11, 95% confidence interval [CI]: 1.85–2.41). However, the odds were lower in current smokers than in passive smokers without a history of cigarette smoking (aOR = 0.71, 95% CI: 0.63–0.79). In addition, the present study found that the odds of developing heart disease increased in respondents from urban areas (aOR = 1.27, 95% CI: 1.14–1.40), aged 46–64 years (aOR = 2.12, 95% CI: 1.90–2.36), and from high-level economic status (aOR = 1.41, 95% CI: 1.27–1.58). Conclusion: Implementing health advocacy initiatives, expanding smoking-free zones, and enhancing workplace anti-smoking policies are important for preventing and reducing the harmful effects of cigarette smoking among workers, particularly those with conditions that make them more susceptible, such as hypertension.