Background: Childhood and adolescent blood pressure pattern have been known to predict adult blood pressure levels and development of hypertension. Hypertension, once rare in traditional African societies, is now the commonest non-communicable disease in Nigeria. There are few studies on adolescent blood pressure pattern, especially in adolescents living in rural areas. It is therefore important to identify blood pressure differences, if any, between adolescents living in rural areas compared to their urban counterparts. Objective: To determine and compare the blood pressure pattern of apparently healthy adolescents in rural and urban areas, and to determine the association between blood pressure and body mass index in these children. Subjects and Methods: A cross sectional population based blood pressure survey was carried out on 2,136 Nigerian school adolescents (1080 were resident in rural areas and 1056 in urban areas) aged 10-18 years, selected from 26 secondary schools using a multi-stage stratified sampling technique. Blood pressure measurements were taken by auscultatory method. An average of three readings was taken as the actual blood pressure. Results: Systolic and diastolic blood pressure increased with age in both rural and urban subjects. The mean systolic blood pressure of the rural subjects (111.10 ± 14.72 mm Hg) was significantly (p= < 0.001) higher than that of the urban subjects (108.09 ±15.40 mm Hg), whilst the mean diastolic blood pressure of the urban subjects (66.88 ± 11.27 mmHg) was slightly higher than those of the rural subjects (66.32±11.71 mmHg. Urban subjects had a higher mean body mass index (19.82± 3.57kg/m 2) than their rural counterparts (19.59±2.78 kg/ m 2).Systolic and diastolic blood pressure showed a positive significant (p= <0.001) correlation with BMI in subjects in rural and urban schools. Conclusion: Significant differences in blood pressure were observed between rural and urban adolescents in Rivers State, with a positive significant correlation between BMI and blood pressure. We recommend blood pressure surveillance as part of the School Health Programme.