Objectives: To examine the risk of cardiovascular disease associated with high-normal blood pressure in English adults and estimate the proportion of these individuals who are at high cardiovascular risk. Design and Setting: Cross-sectional survey of England in 1998. Participants: Nationally representative sample of 12 341 individuals aged 18-80 years living in private households in England. Main outcome measure: Percentage of individuals with high-normal blood pressure who have cardiovascular disease, diabetes mellitus or a 10-year cardiovascular event risk of at least 20%. Results: Of the 12 341 participants, 2413 (19.6%) had high-normal blood pressure. About 5.3% of those aged 18-80 years with high-normal blood pressure had cardiovascular disease or diabetes, and a further 7.6% were at a predicted cardiovascular event risk of at least 20% over 10 years. The mean predicted risk was 8.7% for men and 6.3% for women in the high-normal blood pressure category. The majority of men aged 61-80 years were at high cardiovascular risk. On average, men and women with high-normal blood pressure had a greater incidence of cardiovascular disease and diabetes mellitus, and a greater predicted mean cardiovascular risk than those with normal blood pressure. Extending antihypertensive treatment to individuals with high-normal blood pressure who are at high cardiovascular risk would involve treating an additional 2.5% of the English population aged 18-80 years. Conclusion: These findings support the view that individuals with high-normal blood pressure at high risk for cardiovascular disease should be targeted for blood pressure-lowering treatment. © 2002 Lippincott Williams & Wilkins.