This study highlights the COVID-19 vaccination coverage among older hypertensive patients in Hangzhou, China, as of 3 August 2022. Out of 77,970 individuals, 75.11% had completed the full vaccination, and 57.66% had received a booster dose. The research identified significant disparities in vaccination rates based on gender, region, and age. Moreover, it found that unhealthy lifestyles and various health conditions (cardiovascular disease, cancer, uncontrolled blood pressure, abnormal fasting plasma glucose, dyslipidemia, and renal dysfunction) were associated with lower vaccination coverage. Particularly, individuals with ≥4 risk factors had odds ratios (ORs) of 2.55 for full vaccination and 2.60 for booster vaccination, indicating a significant decrease in vaccination rates compared to those without risk factors. This study underscores the need for targeted efforts to improve COVID-19 vaccination among vulnerable groups, especially those with multiple health risks or comorbidities, and suggests a focus on urban residents.