INTRODUCTIONGlobally raised blood pressure is a major public health problem of concern because of its association with increased risk of cardiovascular diseases. It is the leading cause of death and disability worldwide and accounted for 9.4million deaths and 7% of disability adjusted life years (DALYs) in 2010. 1 Around one billion of adult world population was hypertensive in the year 2000 and this is expected to increase to two billion by 2025. 2 In India, it is the leading Non Communicable Disease (NCD) risk and estimated to be attributable for nearly 10% of all deaths. 3 Adolescence (10-19 years) is an important period of growth and maturation and most of the changes that occur during this period are continued into adulthood. 4 Raised blood pressure in childhood has been recognized ABSTRACT Background: Raised blood pressure is the leading cause of death and disability world-wide. Though hypertension is a problem of adults the aetiologic process and risk behaviours start early in life. The objective of the study was to assess the prevalence and determinants of prehypertension and hypertension among adolescents from high schools in a rural area of Kerala, India. Methods: A cross sectional analytical study was carried out in 1000 adolescents from randomly selected Government, Aided and Unaided high schools of Ettumanoor, Kerala proportionate to sampling frame using WHO designed Global School based student Health Survey (GSHS) questionnaire. Anthropometry and blood pressure recordings were done by trained team members. Statistical analysis was done using SPSS 21. Chi-square test was used to find out the association between categorical variables. Significant variables were entered into logistic regression model to find out Adjusted Odds Ratio (AOR). Results: Out of 1000 study subjects, 409(40.9%) were males and 591(59.1%) were females. Overall prevalence of prehypertension and hypertension was 24.5% (males-30.5%, females-20.3%) and 0.6% (males-0.98%, females-0.34%) respectively. Male sex (AOR-1.67 95%CI-1.23-2.28), low socio-economic status (AOR-1.55 95%CI-1.15-2.11), overweight/obese (AOR-5.7 95%CI-2.4-13.6), low fruit consumption (AOR-2.02 95% CI-1.499-2.7) and high soft drink consumption (AOR-2.21 95%CI-1.446-3.39) were the significant risk factors for prehypertension and hypertension. Conclusion: Male sex, Low socio-economic status, obesity/overweight, low fruit and high soft drink consumption are the significant determinants of Pre hypertension and hypertension among adolescents. The findings may be used in developing messages to provide awareness of dangers of raised blood pressure among adolescents and its behavioural determinants.