Little is known about the natural progression and regression of blood pressure status, even though such knowledge would help determine the best intervention strategies. Our study aimed to explore natural changes in blood pressure status in a middle-aged Chinese population. A total of 6,129 Chinese men and women, aged 35 to 59 years at baseline, from the China Multi-center Collaborative Study of Cardiovascular Epidemiology, were reexamined 6 years later to determine the probability of progression (from non-hypertension to hypertension) and regression (from hypertension to non-hypertension). The majority (80%) of non-hypertensives among the respondents in this study remained normal or pre-hypertensive; about two-thirds of stage 1 hypertensives either stayed at the same stage or regressed to non-hypertension. However, only 9% of stage 2 hypertensives regressed to non-hypertension. Multi-variable logistic regression analysis showed that the stage 1 hypertension group had a 5-fold chance of regressing to non-hypertension in comparison with the stage 2 hypertension group (odds ratio [OR] = 0.2, 95% confidence interval [CI]: 0.1-0.3), whereas the pre-hypertension group had a 4-fold likelihood of progressing to hypertension compared with normotensive subjects (OR = 4.4, 95% CI: 3.7-5.3). After excluding participants ever on drug treatment in either examinations, the OR of regression for stage 2 hypertension was over twice that for stage 1 hypertension (OR = 0.5, 95% CI: 0.3-0.7), and the possibility of progression decreased, though very slightly (OR = 4.3, 95% CI: 3.6-5.1). Weight change significantly influenced progression and regression. Alcohol drinking affected progression significantly. In conclusion, the present findings support the strategy of intensively treating stage 2 hypertension and moderately treating stage 1 hypertension. Persons with pre-hypertension should be monitored for progression and advice on lifestyle modifications should be used.