Objective: To investigate the association between blood pressure and carotid intima-media thickness (IMT) in healthy adolescents. Study design: Study participants included 285 first-year high school students (mean age, 15.2 years) at a rural high school in Korea. Systolic and diastolic blood pressure (SBP and DBP) were measured with an oscillometric automated sphygmomanometer. The carotid arteries were evaluated with high-resolution B-mode ultrasound scanning. IMT value was determined with the average of the maximal IMT at each common carotid artery. Increased IMT was defined as sex-specific top quartile. The odds ratio (OR) for increased IMT per 1 SD increase of SBP and DBP was estimated after adjusting for age, sex, body mass index, waist circumference, fasting glucose level, and total/high-density lipoprotein cholesterol ratio. Results: Adjusted OR for increased IMT was 1.70 (P = .003) per 12.4 mm Hg SBP and 1.25 (P = .125) per 7.0 mm Hg DBP. When the analyses were performed by sex, increased IMT was associated with both SBP (OR, 2.67; P = .003) and DBP (OR, 1.68; P = .019) in girls, but it was not associated with either SBP (OR, 1.46; P = .093) or DBP (OR, 0.99; P = .972) in boys. Conclusion: These results suggest that higher blood pressure level may be associated with increased carotid IMT in apparently healthy adolescents.