We performed the present study to investigate the effects of smoking cessation on changes in blood pressure and incidence of hypertension. We evaluated 8170 healthy male employees at a steel manufacturing company who had received occupational health examinations at the company's health care center in 1994 and were reexamined in 1998. Adjustment covariates were the baseline age, body mass index, cigarette smoking, alcohol consumption, exercise, family history of hypertension, systolic or diastolic blood pressure, and changes in body mass index and alcohol consumption during the follow-up period. The adjusted relative risks of hypertension in those who had quit smoking for <1, 1 to 3, and >/=3 years were 0.6 (95% CI 0.2 to 1.9), 1.5 (95% CI 0.8 to 2.8), and 3.5 (95% CI 1.7 to 7.4), respectively, compared with current smokers. The trends for increased risk of hypertension for longer periods of smoking cessation were observed in subgroups of those who maintained weight as well as those who gained weight after smoking cessation. The adjusted increments in both systolic and diastolic blood pressure were higher in those who had quit for >/=1 year than in current smokers. These trends among weight losers, as well as gainers and maintainers, were similar. We observed progressive increases in blood pressure with the prolongation of cessation in men, although at this time the mechanism remains unknown and must be clarified. This study implies that the cessation of smoking may result in increases in blood pressure, hypertension, or both.