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Waist-to-height ratio (WHtR) is proposed as a simple and effective screening tool for abdominal obesity and cardiovascular disease risk factors. The present study examined the profiles of blood pressure (BP) among children and adolescents categorized by WHtR cutoffs.A total of 28 074 (14 015 boys and 14 059 girls) students aged 7–17 years participated in the study. Height, waist circumference and BP of all patients were measured, and WHtR was calculated. Relatively high blood pressure (RHBP) status was defined as systolic BP and/or diastolic BP of at least the 95th percentile for age and sex. All patients were divided into three groups (low, moderate and high) according to their WHtR. BP level and the prevalence of RHBP among the three groups were compared.In both boys and girls, significant differences in BP level and the prevalence of RHBP were observed among the three groups (P<0.01). Children and adolescents aged 7–17 years in the ‘high WHtR group’ (≥0.5) had higher systolic BP and diastolic BP compared with those in the ‘low WHtR group’ (<0.4) by 6.07–11.49 and 3.28–6.34 mmHg for boys and 5.62–9.76 and 3.14–5.95 mmHg for girls; the ‘high WHtR group’ had the highest (34.02% for boys and 30.87% for girls) and the ‘low WHtR group’ had the lowest prevalence of RHBP (15.23% for boys and 12.53% for girls).High WHtR is associated with elevated BP. These findings emphasize the importance of the prevention of abdominal obesity to prevent future problems such as hypertension in children and adolescents.