Objective: To analyze the cumulative effect of preadolescent lifestyles on the prevalence and incidence of elevated blood pressure (EBP) in children, and to provide evidence for early hypertensive intervention. Methods: In 2017, a cohort study on pubertal development was conducted in Xiamen, Fujian Province. Participants underwent a physical examination and questionnaire survey. Between 2017 and 2019, this study carried out a 2-year follow-up of 1 316 students whose complete data were obtained. Preadolescent lifestyles were assessed by referring to baseline survey results obtained in 2017, and the prevalence and incidence of EBP were determined according to blood pressure levels that were determined in 2019. The logistic regression model was used to analyze the influence of healthy lifestyles on the prevalence and incidence of EBP after adjusted for confounding factors. Results: The prevalence of EBP in 2017 and 2019 was 25.0% and 23.3%, respectively, and its incidence was 18.9% after the 2-year follow-up. Children with a healthy lifestyle had a lower prevalence and incidence of EBP. The regression analysis showed that children who have more healthy lifestyle factors were at a lower risk of EBP (P<0.05). Compared with students with 0-2 healthy lifestyle factors, the OR value of EBP prevalence was 0.52 (95% CI=0.30-0.90) and the RR value of EBP incidence was 0.60(95%CI=0.29-1.22) in children with 4-5 healthy lifestyle factors. Among them, children who were overweight or obese were at a significantly lower risk of EBP prevalence (OR=0.29, 95%CI=0.10-0.81). Conclusion Preadolescent lifestyles seemed to have a cumulative effect on the occurrence of EBP. Maintaining a healthy lifestyle had a positive effect on reducing the risk of EBP, particularly in overweight and obese children, and this was due to their adoption of a comprehensive healthy lifestyle.