Objective: To examine the relationship between clustering of metabolic abnormalities with non-alcoholic fatty liver disease (NAFLD) in hypertensive children and adolescents, and to provide a scientific reference for the prevention and control of NAFLD among children and adolescents. Methods: Data were based on a school-based cross-sectional study conducted from September 2012 to September 2014 in Jinan. A total of 261 hypertensive children and adolescents aged 6 to 17 years were included in this study. Chi-square test was used to analyze the prevalence of NAFLD by numbers of metabolic abnormalities. Multivariable logistic regression model was used to examine the relationship between clustering of metabolic abnormalities and NAFLD in hypertensive children and adolescents after adjustment for potential confounding variables. Results: Among the included 261 hypertensive participants, the prevalence of NAFLD with the number of metabolic abnormalities ≤1, 2 and ≥3 was 5.3%, 25.5% and 36.0%, respectively. After adjustment for sex, age and systolic/diastolic blood pressure, compared with hypertensive children and adolescents carrying ≤1 metabolic disorder, those with two metabolic disorders had 6.51 (95%CI=2.52-16.81) times higher risk for NAFLD, and those with≥3 metabolic disorders had 8.89 (95%CI=3.03-26.06) times higher risk. Conclusion Clustering of metabolic abnormalities is an independent risk factor for NAFLD in hypertensive youth. Comprehensive prevention and control of metabolic disorders in childhood may be helpful to prevent NAFLD.