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BACKGROUND The evolution of hypertension (HT) subtypes in young-to-middle-age subjects is unclear. METHODS We did a prospective study in 1,141 participants aged 18-45 years from the HARVEST study screened for stage 1 HT, and 101 nonhypertensive subjects of control during a median follow-up of 72.9 months. RESULTS At baseline, 13.8% ofthe subjects were classified as having isolated systolic HT (ISH), 24.8% as having isolated diastolic HT (IDH), and 61.4% as having systolic-diastolic HT (SDH). All hypertensive groups developed sustained HT (clinic blood pressure ≥140/90 mm Hg from two consecutive visits occurring at least after ≥6 months of observation) more frequently than nonhypertensive subjects (P < 0.001 for all) with adjusted odds ratio of 5.2 (95%Cl 2.9―9.2) among the SDH subjects, 2.6 (95%Cl 1.5―4.5) among the IDH subjects, and 2.2 (95%Cl 1.2―4.5) among the ISH subjects. When the definition of HTwas based on ambulatory blood pressure (mean daytime blood pressure ≥135/85 mm Hg, n = 798), odds ratios were 5.1 (95%Cl 3.1-8.2),5.6 (95%Cl 3.2―9.8), and 3.3 (95%Cl 1.7―6.3), respectively. In the fully adjusted logistic model, the riskof ambulatory HT was smaller for the ISH than the IDH (P=0.0 49 ) or SDH (P = 0.053) individuals. CONCLUSIONS The present results indicate that young-to-middle-age subjects with ISH have a smaller risk of developing ambulatory HTthan either subjects with SDH or IDH. Whether antihypertensive treatment can be postponed for long periods of time in young subjects with mild elevations of clinic systolic BP and low global cardiovascular risk should be examined in further studies.