Background High blood pressure (BP) is a common risk factor for cerebral small vessel disease including white matter hyperintensity (WMH). Whether increased BP exacerbates WMH by impacting cerebral vascular morphologies remains poorly studied. Purpose To determine the relationships among high BP, cerebrovascular morphologies, and WMH in elderly individuals. Study Type Cohort. Subjects Eight hundred sixty‐three participants (54.2% female) from the Taizhou Imaging Study without clinical evidence of neurologic disorders were included in the analyses. Field Strength/Sequence 3.0 T; time‐of‐flight magnetic resonance angiography (TOF MRA); T2 fluid‐attenuated inversion recovery (FLAIR); T1 magnetization‐prepared rapid gradient‐echo; gradient echo T2*‐weighted; diffusion tensor imaging; pulsed arterial spin labeling. Assessment Cerebrovascular morphologic measurements were quantified based on the TOF MRA images, including vessel density, radius, tortuosity, and branch number. WMH lesion volumes (WMHV) and WMH lesion counts (WMHC) were calculated automatically based on the T2 FLAIR images. Statistical Tests Multivariable linear regression analysis and path analysis with a linear single‐mediator model were employed. A P value <0.05 was considered statistically significant. Results Higher BP, especially diastolic BP, was significantly correlated with lower cerebrovascular density (β = −104) and lower branch numbers (β = −0.02). Although decreased tortuosity (β = −1.25) and increased radius (β = 93.8) were correlated with BP, no significant relationship of tortuosity (β = −4.6 × 10−4, P = 0.58) or radius (β = 0.03, P = 0.08) with BP in small vessels was found. The proportion of small vessels decreased as BP increased (SBP: β = −6.6 × 10−4; DBP: β = −9.0 × 10−4). Similarly, increased WMHV and WMHC were associated with decreased vessel density (volumes: β = −24, counts: β = −127), decreased tortuosity (volumes: β = −0.08, counts: β = −0.53), and increased radius (volumes: β = 12.6, counts: β = 86.6). Path analyses suggested an association between high BP and WMHs that were mediated by cerebrovascular morphologic changes. Data Conclusion Structural alterations of cerebral vessels induced by high BP are correlated with WMH. This result suggested that elevated BP might be one of the pathophysiological mechanisms involving in the co‐occurrence of cerebrovascular alteration and small vessel disease. Level of Evidence: 1 Technical Efficacy Stage: 1