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To assess the relationship between resting heart rate (HR) and the risk of cardiovascular disease (CVD) among Chinese people in different blood pressure stages.A total of 19,558 participants aged ≥35 years and free of CVD were enrolled at baseline in 1992 and followed up for up to 20 years. Participants were stratified by baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) and resting HR. Hazard ratios (HR) of CVD incidence and mortality associated with HR by blood pressure categories were analyzed using Cox proportional hazards models, after adjusting for age, sex, smoking status, diabetes, total cholesterol, high-density lipoprotein cholesterol, and antihypertensive medications at baseline.There were 1,525 cardiovascular events and 382 cardiovascular deaths. The CVD incidence rates were 543.7, 561.8, and 617.9 per 100,000 person-years for participants with HR of < 70 bpm,70–89 bpm, and ≥90 bpm, respectively, and the counterpart rates of CVD mortality was 122.1, 135.2 and 203.4 per 100,000 person-years. After adjustment, the risk of CVD incidence and mortality both increased significantly in prehypertensives (SBP/DBP 120–139/80–89 mm Hg) with HR ≥90 bpm, with the HR (95% CI) of 1.99 (1.29–3.08, p = 0.002) for CVD incidence and 2.33 (1.03–5.27, p < 0.001) for mortality (Figure 1), compared with that for normotension (SBP/DBP < 120/80 mm Hg) and HR < 70 bpm. Trends for the CVD risk associated with increasing HR were not found in participants with normotension or hypertension (SBP/DBP ≥140/90 mm Hg or on treatment).Elevated HR in Chinese adults with prehypertension are associated with higher risk of CVD incidence and mortality, which deserves further investigations for the potential benefit of HR management.