The objective of this study was to examine the association between body mass index (BMI) and blood pressure. Two sets of cross-sectional data were obtained from annual health examinations for adults aged 40 years and over (n=1,327 in 1993; n=1,302 in 2000) in Tsunagi area of Kumamoto Prefecture, Japan. BMI was associated with mean blood pressure and with prevalence of hypertension both in 1993 and 2000. The association was independent of age, smoking status and alcohol consumption. A significant increase in risk of hypertension was found in most categories of BMI 25.0 and above, and a greater than three fold increase in those with BMI of 27 and above compared with those with BMI of 18.5-22.9. Although mean blood pressure and prevalence of hypertension sharply decreased in 2000 compared with that in 1993, BMI was positively and independently associated with increased blood pressure.