AbstractA five‐year follow‐up sample of 509 adult male and female Samoans experiencing modernization in American Samoa was studied to determine the relation between baseline biocultural factors and follow‐up blood pressure level. Analyses were stratified by sex and baseline age: 18–44 and ≥45 years. Baseline factors in the predictive models included blood pressure level, sum of skinfolds, age, education level, and reported salt intake. This Samoan adult sample was characterized by high prevalence of overweight at all ages, continual fat gain, and high incidence of overweight in young adults over five years. Blood pressure levels were moderate in young adults considering the adiposity, although almost one‐third of those ≥45 years of age were hypertensive. In young adults baseline adiposity was the most important predictor of follow‐up blood pressure, whereas in older adults age itself was most important. As age increases, physiologic blood pressure regulation may become less labile due to long‐term adiposity and salt intake and lead to persistent elevations