Hypertension is becoming increasingly prevalent among western societies. However, different ethnic groups appear to be affected unequally. This systematic review sought to evaluate blood pressure and hypertension among North American Indigenous populations. Electronic databases (e.g. MEDLINE and EMBASE) were searched and citations cross-referenced. Articles including blood pressure or hypertension among Indigenous populations specifically were included. A total of 1213 unique articles were identified, with 141 included in the final review. Hypertension rates ranged from 19.2% among Inuit/Alaskan natives to 33.9% among First Nations/American Indians, and have increased since pre1980. Overall, hypertension rates were lower among Indigenous populations compared with general populations (23.5 vs. 31.2%), although average blood pressures were similar (123.3/75.1 vs. 124.9/75.2 mmHg). Limited information regarding Indigenous children/youth identified 11.4% hypertension rates, with average blood pressures of 106.7/60.2 mmHg. These findings indicate that current rates of hypertension may actually be lower among Indigenous populations than the general population.