Obstructive sleep apnea (OSA) is a common condition among patients with hypertension and treatment with continuous positive airway pressure (CPAP) can decrease blood pressure (BP). However, CPAP is not well tolerated by a significant proportion of patients. The authors investigated the effects of acupuncture on OSA severity and BP control in patients with hypertension. Hypertensive patients with mild to moderate OSA (apnea–hypopnea index, 5–30 events/hr) were randomly assigned to receive acupuncture or sham‐acupuncture treatment. Patients were assessed at baseline and after 10 acupuncture sessions using polysomnography, 24‐hr ambulatory BP monitoring and a quality of life questionnaire. Forty‐four patients (34% men; mean age, 57.0 ± 5.4 years; body mass index, 29.6 ± 3.2 kg/m2; apnea–hypopnea index, 16.3 ± 6.7 events/hr) completed the study. There were no differences in pre–post‐intervention apnea–hypopnea index, daytime or nocturnal BP, or quality of life between the acupuncture and sham‐acupuncture groups (p > .05). Acupuncture therapy in hypertensive patients with OSA did not reduce OSA severity, daytime or nocturnal BP, or quality of life.