Conflicting results have been reported in studies evaluating the relationship with healthy obese phenotype with a favorable cardiovascular profile and the risk of cardiovascular mortality. We prospectively investigated the association between obesity phenotype and the incidence of hypertension. A total of 4072 participants, age 40 to 69 years at baseline, without hypertension were included from the Korean Genome Epidemiology Study. According to body mass index (BMI) and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI <23 kg/m2), unhealthy (one or more of five MetS components) normal weight, healthy overweight (BMI 23 to 24.9 kg/m2), unhealthy overweight, healthy obesity (BMI ���25 kg/m2), and unhealthy obesity. Incident cases of hypertension were identified by biennial health examinations during 8 years of follow-up. After adjusting for age, sex, physical activity, smoking, alcohol consumption, and family history, increased risks for hypertension were observed in unhealthy normal weight (hazard ratio 2.38, 95% CI 1.85 to 3.05), unhealthy overweight (hazard ratio 3.20, 95% CI 2.51 to 4.07), healthy obesity (hazard ratio 2.27, 95% CI 1.60 to 3.23), and unhealthy obesity (hazard ratio 3.63, 95% CI 2.88 to 4.56) compared with healthy normal weight. In a subgroup without prehypertensives, healthy obese individuals were still associated with a higher incidence of hypertension (hazard ratio 1.96, 95% CI 1.20 to 3.19). Obese individuals without MetS components were at increased risk for hypertension. These findings provide evidence that metabolically healthy obese phenotype may not be a benign condition.