Hypertension in adolescents is still a debatable subject in regard to prognosis. Conclusions on the significance of "prehypertension" have been divided and no long-term follow-up has been reported in a representative population. In a group of 435 adolescents of the Evans County Epidemiologic Study, 11% had hypertension (≥140 and/ or ≥90 mm Hg) in 1961. After seven years, 30 of this group were reevaluated. Two deaths from cerebral hemorrhage occurred. One patient has hypertensive heart disease; sustained hypertension with cardiovascular and cerebrovascular symptoms developed in three more. Five were found to have asymptomatic sustained hypertension. Seven more had hypertension not reaching levels of sustained hypertension (≥160 and/or ≥95 mm Hg). Twelve have become normotensive. The most impressive associated finding was overweight and subsequent weight gain in eventual sustained hypertensives.