Abstract-That essential hypertension is associated with metabolic syndrome is known. However, information is scant regarding the course of development of adverse levels of blood pressure and other risk variables of metabolic syndrome in youth at risk for developing hypertension. This aspect was studied, retrospectively, in a community-based cohort of normotensive (nϭ2206), prehypertensive (nϭ721), and hypertensive (nϭ328) subjects examined serially during childhood (4 to 11 years), adolescence (12 to 18 years), and adulthood (19 to 42 years). Prehypertensive subjects versus normotensive subjects had significantly higher body mass index and subscapular skinfold, systolic (SBP) and diastolic (DBP) blood pressures, and triglycerides beginning in childhood; higher glucose in adolescence; and higher low-density lipoprotein cholesterol, fasting insulin, and insulin resistance index in adulthood. Hypertensive subjects versus normotensive subjects had higher adiposity measures, SBP and DBP, glucose, and triglycerides beginning in childhood; higher insulin and insulin resistant index in childhood and adulthood; and lower high-density lipoprotein, cholesterol in adulthood.Most of these variables progressed adversely at an increased rate in prehypertensive and hypertensive subjects. In a multivariate analysis, adverse changes in adiposity, SBP, and DBP were independently associated with prehypertensive status; and adverse changes in adiposity, SBP and DBP, insulin resistant index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides with hypertension status. As young adults, prehypertensive and hypertensive subjects showed significantly higher prevalence of obesity, hyperinsulinemia, hyperglycemia, and dyslipidemias. Thus, excess adiposity and blood pressure beginning in childhood and accelerated adverse longitudinal changes in risk variables of metabolic syndrome through young adulthood characterize the early natural history of hypertension. Key Words: hypertension, essential Ⅲ metabolism Ⅲ insulin Ⅲ lipids Ⅲ metabolic syndrome Ⅲ children Ⅲ young adults Ⅲ risk factors E ssential hypertension is an important risk factor for morbidity and mortality from coronary heart disease, stroke, and renal disease. [1][2][3] Although clinical manifestations of hypertension do not generally emerge until middle age, the pathophysiologic precursors of adult hypertension are thought to originate very early in life, including the period of fetal development. [4][5][6] Recognizing the importance of the evolution of high blood pressure levels from childhood to adulthood, as part of the early natural history of essential hypertension, the National High Blood Pressure Education Programs for adults 7 and children 8 provided guidelines for prevention and control of hypertension.It is well recognized that hypertension, in general, does not occur in isolation but coexists in varying degrees with conditions of obesity, insulin resistance/hyperinsulinemia, and dyslipidemia, the interrelated metabolic disorders ...