Purpose: We have first reported that the new progression of carotid artery plaque (C-plaque) is a risk factor for incident cardiovascular disease (CVD), but there have been no reports on the risk factors associated with newly progression of C-plaque. Methods: We studied 4,724 Japanese men and women (mean age 59.7 years) without CVD whose intima-media thickness (IMT) was measured with carotid ultrasonography on both sides of the entire carotid artery areas as a baseline survey (April 1994 to August 2001). C-plaque was defined as a maximum IMT of the common carotid artery more than 1.1mm. We excluded subjects with carotid artery plaque at baseline (n=1,044), lost to follow-up (n=167), and missing data (n=2). Carotid ultrasonographic follow-ups for 3,511 subjects were performed every two years until March 2016. Blood pressures (BPs) were used the average of two measurements recorded more than 1 min apart. We analyzed multivariable-adjusted Cox proportional hazard regression models for incident C-plaque progression according to BP categories by the ESC/ESH 2018 guideline. Results: During 38,457 person-years of follow-up, 1,771 new progressions of C-plaque occurred. The incident new progression of C-plaque per 1000 person-years was 39.9, 4.8, 50.6, 56.3, and 60.6 for optimal, normal, and high normal systolic BPs, and grade I and II+III systolic hypertension, respectively. Compared to the optimal BP, the adjusted HRs (95% CIs) for incident progression of C-plaque were 1.14 (1.00-1.30), 1.18 (1.03-1.35), 1.18 (1.02-1.36), and 1.32 (1.06-1.64), respectively. The adjusted HRs (95% CIs) for incident C-plaque progression were 1.21 (1.06-1.39) and 1.27 (1.07-1.50) for pulse pressures 50-59 mm Hg and ≥60 mm Hg, based on the subjects with pulse pressure <40 mm Hg. Compared to subjects with optimal BP without antihypertensive medication, the adjusted HRs (95% CIs) for incident C-plaque progression were not significant in controlled BP but increased the risk of incident C-plaque in poor-controlled hypertension (HR=1.21, 95% CIs=1.05-1.38). Conclusion: A community-based cohort study showed for the first time that high BP levels lead to new progression of incident C-plaque. It is first shown that BP control contributes to the suppression of plaque development.