BackgroundCross-sectional studies have revealed a link between low muscle mass and hypertension. However, whether the degree of muscle mass predicts hypertension risk has not been confirmed. This study aimed to verify an association between skeletal muscle mass and incident hypertension in a longitudinal follow-up of middle-aged Korean adults.MethodsThe community-based prospective Korean Genome and Epidemiology Study (KoGES) data from 2,669 participants who were free of hypertension at baseline were prospectively assessed at 2-year intervals for 16 years. The participants were divided into tertiles T1–T3 of relative skeletal muscle mass (RSM) according to their baseline whole-body skeletal muscle mass measured as bioelectrical impedance. Incident hypertension was estimated using multivariate logistic regression with the Cox proportional hazard regression model.ResultsOver the 16-year follow-up, the rates of incident hypertension at RSM T1, T2, and T3 were 18.7, 17.1, and 13.4% in men (P for trend = 0.0002) and 18.8, 14.7, and 12.9% in women (P for trend = 0.0007), respectively. The multivariate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the incidence of hypertension for men and women in T1 and T2 were 1.36 (1.11–1.67) and 1.59 (1.31–1.94), and 1.20 (0.99–1.46) and 1.70 (1.41–2.04), respectively, compared with T3 as the reference.ConclusionA low skeletal muscle mass in middle-aged Korean men and women was significantly associated with incident hypertension in later life. Further investigation is needed to comprehend the mechanisms of this relationship and validate the findings in a large cohort.