Purpose: Analyzed the associations of sedentary behavior (SB) measured by questionnaire and accelerometer, with cardiometabolic markers in adolescents. Methods: Longitudinal study with 4 years of follow-up with adolescents from João Pessoa, Brazil. SB was measured using a questionnaire (305 adolescents: 54.5% females; age 11.7 [SD = 0.7]) and use of accelerometer (136 adolescents: 54.8% females; age 11.5 [SD = 0.7]). The cardiometabolic markers were body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins (HDL-C), total cholesterol/HDL ratio, triglycerides/HDL ratio, and non-HDL-C. Generalized Estimating Equation analysis was used to for analyses. Results: The average time in SB by the accelerometer was greater (average 8.3 [SD = 1.5], 8.8 [SD = 1.6], and 8.4 [SD = 1.9] h/d/wk) than observed in the questionnaire (on average 6.0 [SD = 4.1], 7.2 [SD = 4.9], and 6.6 [SD = 5.4] h/d/wk), in all years of the study, but without a significant increasing trend (P > .05) over time for both measures. There was a significant and positive association between SB measured by the questionnaire and SBP (β = 0.148; 95% CI, 0.021–0.274). Conclusions: The SB generally does not seem to contribute to significant changes in cardiometabolic markers in adolescents, despite it being associated with increased systolic blood pressure levels.