Background: Several anthropometric indices such as body mass index (BMI) and waist circumference (WC) have been examined as indicators of cardiovascular diseases in both adults and children. Waist-to-height ratio (WHtR) has been considered a superior predictor for detecting cardiovascular risk factors than BMI. We investigated the association between WHtR and incident hypertension in prospective study. Methods: A total of 1,718 subjects aged 39-72 years in a longitudinal study were recruited. Participants were divided into two groups according to development of hypertension during 2005-2008 (baseline) and 2008-2011 (follow-up). Logistic regression models were used to evaluate WHtR as a significant predictor of the hypertension. Results: During 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were diagnosed with an incidence rate of approximately four percent per year. The WHtR was significantly higher in the subjects who had developed hypertension than in those who had not (0.54±0.05 vs. 0.51±0.05, p <0.001). After adjusted for baseline age, gender, smoking status, alcohol intake, regular exercise, total cholesterol (LDL), and systolic blood pressure (SBP), logistic regression analysis indicated participants with the highest quartile of WHtR (WHtR≥0.54) were 4.51 times more likely to have hypertension than those with the lowest quartile (OR 4.51; 95% CI 2.41-8.43; p<.0001). The area under the curve (AUC) for WHtR in identifying hypertension risk was significantly greater than BMI (p=0.0233). Conclusion: A positive association between WHtR and the incidence of hypertension was found in Korean adults. We assumed the WHtR may be a better predictor of incident hypertension in a community-based prospective study.