Red dominated the room's design when John Adams II, the son of President John Quincy Adams, married Mary Catherine Hellen here on February 25, 1828. Andrew Jackson fitted the room out in green. Martin Van Buren redecorated the "Elliptic Saloon" and started the tradition of a "Blue Room" in 1837. In 1848, gas lighting was piped to all the chandeliers on the State Floor except the Blue Room. Sarah Polk thought candles looked better in Monroe's luster, an elegant fixture that was reputed to have belonged to Napoleon. She was vindicated when on the first night that it was used, gas ran out and all went dark except the candlelit oval room.

In 1860, President James Buchanan sold the Bellangé chairs and sofas at auction and replaced them with a Victorian Rococo Revival suite that served into the Theodore Roosevelt administration. In 1882 President Chester Arthur commissioned Louis Comfort Tiffany to redecorate several State Rooms. Tiffany tinted the walls of the Blue Room in a light green "robin's egg blue" which became lighter toward the ceiling and culminated in an ivory and silver frieze of hand-pressed paper. The Rococo Revival furniture was kept and reupholstered in blue silk canvas. Grover Cleveland - the first president to marry in the White House - wed Frances Folsom in the Blue Room in 1886.

In 1902, Theodore Roosevelt hired McKim, Mead & White to renovate the White House. Charles McKim restored the Empire décor and designed a set of furniture comparable to the Bellangé originals. The walls were covered with heavy, steel blue ribbed silk, woven to match a sample from the Napoleonic era. In 1948, the chandelier in the Blue Room tinkled a warning that the interior structure was in a shaky condition. President Harry Truman directed a major renovation that reconstructed the interior of White House on a new foundation and steel frame. In the rebuilt Blue Room, project architect Lorenzo Winslow restored James Hoban's original cornice design and continued McKim's silk wall coverings. In 1962, Jacqueline Kennedy directed the room's redecoration, covering the walls with a cream-colored satin. By that time, the White House had acquired three of the original Bellangé chairs auctioned off in 1860, from which copies were made. Ten Bellangé pieces have been recovered to date and share the room with several reproductions.

On the mantle is a bronze-dore clock bearing the figure of the Carthage general Hannibal. The clock, made by French bronze casters Deniere and Matelin, was one of a pair bought by Monroe in 1817. Monroe also acquired three marble busts—Amerigo Vespucci, Christopher Columbus, and George Washington—all made by the Italian sculptor Giuseppe Ceracchi.

Paintings of presidents are also on display. John Tyler's 1859 portrait by George P. A. Healy is one of the finest in the White House Collection. Ander Zorn's portrait of President William Howard Taft shows the Blue Room of 1911. An 1819 portrait of James Monroe by Samuel F. B. Morse, who later patented the telegraph, hangs prominently in the room.

The Blue Room still serves as a reception area, most notably during the holidays, when adorned by the official White House Christmas tree. Many distinguished guests have been received here. In 1822, James Monroe had tea and cake with chiefs of the Great Plains Indian tribes. In 1878, Rutherford B. Hayes accepted the credentials of the first Chinese minister to the United States. The Blue Room has also welcomed at least one child. During the Dwight Eisenhower administration, the christening of granddaughter Mary Jean within these curving walls reminded the country that the White House is more than an icon of the presidency — it is home to a family.