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Objectives: Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia. Methods: A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0. Results: The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio = 3.144), being male (adjusted odds ratio = 3.073), being Chinese (adjusted odds ratio = 2.321) or Iban (adjusted odds ratio = 1.578), central obesity (adjusted odds ratio = 2.145), being overfat (adjusted odds ratio = 1.885), and being an older adolescent (adjusted odds ratio = 1.109). Parental history of hypertension, locality, and physical activity showed no significant associations. Conclusion: The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.