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The environment where people live is known to affect their health. A relatively new field of research examines how urban design may influence residents’ health through facilitating or hindering physical activity. Although physical activity has a preventative effect on developing chronic diseases, evidence on the impact of urban design on cardiovascular health has not yet been synthesized. This study reviewed the current evidence on longitudinal relationships between urban design attributes and hypertension among adults.We conducted a systematic review of peer-reviewed journal articles (published from January 2000 to July 2016) that examined longitudinal relationships of urban design attributes with hypertension. We assessed the methodological quality of the articles and applied a meta-analytic approach using weighted Z-test to quantify the strength of evidence.We identified six studies that examined the longitudinal relationships between neighborhood walkability (a measure of how a local area is conducive to walking, typically consisting on dwelling density, land use diversity, street layout) and hypertension. Meta-analysis found very strong evidence for prospective associations between neighborhood walkability and hypertension (p < 0.001). There were two studies on access to recreational facilities (e.g., parks, sports grounds, gyms) and hypertension, which found no significant associations.The findings suggest that living in or moving to more walkable areas are likely to be protective against developing hypertension over time, potentially due to physically-active lifestyle of residents in such areas. Further research is needed to investigate the effects of other urban design attributes on hypertension.