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The relationship between childhood risk factors and long-term arterial stiffness was explored.A baseline survey was conducted in 4623 school children aged 6–15 years in rural areas of Hanzhong city, Shaanxi, in 1987. According to three independent measurements of SBP in 1987, 1989, and 1992, cases of the same age and sex with continuous SBP at least 75 percentile were classified as the high–blood pressure (BP) group, whereas those with SBP less than 50 percentile were classified as the normal-BP group. The cohort was followed up again after 26 years (in 2013). Blood biochemistry indexes, including fasting glucose, uric acid, and blood lipid, were measured. Brachial–ankle pulse wave velocity (baPWV) was recorded by noninvasive automatic waveform analyzer.Follow-up rate was 71.6%. The high-BP group had a higher incidence of hypertension (39.5 vs. 18.0%, P < 0.01) and baPWV (1337.2 ± 198.3 vs. 1271.7 ± 204.3 cm/s, P = 0.028) than the normal-BP group during the follow-up period. Positive correlation was found during follow-up between baPWV and childhood SBP, as well as SBP, DBP, BMI, heart rate, total cholesterol, low-density lipoprotein cholesterol, triacylglycerol, fasting glucose, and uric acid in adulthood (all P < 0.05). Results from stepwise multivariate regression analysis showed that men, family history of hypertension, SBP at both baseline and follow-up, fasting glucose, and uric acid in adulthood are independent impact factors of baPWV in adults.Higher SBP in children and adolescents, family history of hypertension, and male sex may increase the risk of developing long-term arterial stiffness.