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Background Little is known regarding the association of changes in blood pressure level with risk of all-cause and cardiovascular disease (CVD) mortality in young adults.Methods This cohort study from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) consisted of 9977 adults aged from 18 to 40 years by following up until the date of death or December 31,2015.Participants were categorized by blood pressure readings using the blood pressure classification of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Clinical Practice Guidelines:normal (systolic,＜120 mm Hg;diastolic,＜80 mm Hg),elevated (systolic,120-129 mm Hg;diastolic,＜80 mm Hg),and hypertension (systolic,≥ 130 mm Hg;diastolic,＞80 mm Hg).Multivariable Cox proportional hazard models yielded adjusted hazard ratios (HRs) and 95％ confidence intervals (CIs) of CVD and all-cause mortality.Results A total of 8356 participants (median age,26.63 ± 7.01,3758 women [44.97％]),of whom 265 (3.17％) all-cause and 10 (0.12％)CVD mortality were observed during a median follow-up duration of 152.96 ± 30.45 months.All-cause mortality incidence rates for normal blood pressure,elevated blood pressure,and hypertension were 172 (2.91％),43 (3.52％),and 50 (4.10％),respectively.With the normal blood pressure group being a reference,from elevated blood pressure to hypertension group,adjusted HRs for all-cause mortality were 1.24 (95％ CI,0.63-2.42) and 1.52 (95％ CI,0.83-2.80) (P=0.162) after adjustment for potential confounders.Conclusions Among young adults,those with elevated blood pressure and hypertension,compared with those with normal blood pressure before the age of 40,as defined by the blood pressure classification in the 2017 ACC/AHA guidelines,are not significantly associated with increased risk of subsequent all-cause mortality.