Abstract Background To investigate the regional prevalence of hypertension, overweight, and obesity among adolescents aged 11–17 years in Xuzhou. The relationships between overweight, obesity, abdominal obesity, age, gender, grades, and hypertension were studied. Methods The stratified cluster random sampling method was used and the middle school students from the first to the third grade of 10 junior and senior middle schools in Xuzhou were involved. Blood pressure, weight, height, and waist circumference were measured for each participant. Hypertension was diagnosed according to the standards of high blood pressure by gender, age, and height of children aged 3–17 in China in 2017. Overweight and obesity were defined based on the standards of the Chinese Obesity Working Group. Abdominal obesity was defined as waist-to-height ratio >0.46. Results A total of 10,004 students aged 11–17 years were enrolled with 4,774 females and 5,230 males. The prevalence of hypertension was 9.8% in all participants, 7.2% in females, and 12.2% in males. There were 1,495 students with obesity (14.9%), and 1,698 with overweight (17.0%). The prevalence of hypertension was 5.6%, 12.8%, and 25.4% in normal weight, overweight, and obese adolescents, respectively. A multivariate analysis showed that males (odd ratio, 95% confidence interval: 1.450, 1.256–1.674), age (1.770, 1.537–2.037), overweight (1.858, 1.465–2.357), obesity (4.010, 3.084–5.214), abdominal obesity (1.497, 1.184–1.892), and third grade (1.488, 1.250–1.772) were risk factors for adolescent hypertension. The risk of hypertension in male adolescents over 14 years old was 2.456 times than that of adolescents under 14 years old, while there was no significant difference in the risk of hypertension between female adolescents over and under 14 years old. In adolescents with normal weight, subjects with abdominal obesity had a much higher risk of hypertension compared with those without abdominal obesity (1.848, 1.334–2.559). Conclusions The prevalence of hypertension among adolescent school students in Xuzhou is high. Overweight and obesity are independent risk factors of hypertension in adolescents.