In 2007, Rolling Stone Japan ranked Blue Blood number 15 on their list of the "100 Greatest Japanese Rock Albums of All Time".

Two of the concerts sold out in advance, including the March 16 show at Shibuya Public Hall, which was later released on home video as Blue Blood Tour Bakuhatsu Sunzen Gig.

[2] X went on the Rose & Blood Tour in September, which was temporarily suspended when Yoshiki collapsed after a November 22 concert, but then continued into May 1990.

[4] A special edition of Blue Blood, which included a second disc of instrumental versions of some songs, was released on February 14, 2007, and reached number 23 on the Oricon chart.

[5] Blue Blood contains re-recordings of their second single "Orgasm" and its b-side "X", as well as "Kurenai" and "Unfinished" from their debut album Vanishing Vision, all with alternate/expanded lyrics.

Blue Blood leans more towards symphonic metal than its predecessor, with "Rose of Pain" including portions from Johann Sebastian Bach's "Fugue in G Minor".

The songs "X" and "Orgasm" have many of X's friends, fellow musicians and members of bands on Extasy Records providing backing vocals, namely Baki from Gastunk, Tusk, Ken and Seiichi from Zi:Kill, Haruhiko Ash (The Zolge, Eve of Destiny), and members of Ladies Room.

Alexey Eremenko, of Allmusic, said "staying on the coordinate grid set by Iron Maiden, Guns N' Roses, Queensrÿche and perhaps updated Thin Lizzy, with the results being not too far from what Helloween were doing at the time", also argues that "whether or not the Germans influenced X Japan is up for debate, but the similarities are obvious, as the Japanese exhibit the same aptness for combining menacing guitar work with anthemic... cinematic... melodies".

Carl Begai said that "Blue Blood is and will remain one of the few damn near perfect albums in my eyes for the simple fact it never lets up and never gets lazy, even when things slow down for a cheeseball ballad or two.

"[18] He wrote that with it X "created some of the boldest music I’d ever heard, daring to thrash through tracks like ‘X’, and ‘Orgasm’, serve up epics like ‘Rose Of Pain’ and ‘Kurenai’ (one of my Top 3 metal songs of all time), [and] deliver a song like ‘Endless Rain’ that Elton John would be happy to call his own, and all on the same album."

"[20] On their 2007 list of the "100 Greatest Japanese Rock Albums of All Time", Rolling Stone Japan ranked Blue Blood number 15.

hide also performed the song live during some of his solo concerts, and a studio version was completed after his death and put on the 2002 Singles ~ Junk Story compilation.