Purpose: We aimed to estimate the association between prehypertension (PHT) and clustering of cardiovascular disease (CVD) risk factors among Chinese adults. Methods: A cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years was conducted during 2000-2001. Results: Overall, 79.4%, 40.0%, and 11.0% of Chinese adults with PHT (120-139/80-89 mm Hg) had > 1, >= 2; and >= 3 modifiable CVD risk factors (dyslipidemia, impaired fasting glucose/diabetes, cigarette smoking, and overweight/obesity), respectively. The adjusted odds ratio (95% confidence interval, CI) of having >= 1, >= 2, and >= 3 CVD risk factors was 1.41 (1.24-1.61), 1.45 (1.30-1.61), and 1.96 (1.67-2.29), respectively, for adults with PHT compared with those with optimal blood pressure by multivariate models. Moreover, population attributable risk percent of having >= 1, >= 2, and >= 3 CVD risk factors was 16.7%, 18.0%, and 31.9%, respectively, for adults with PHT. Furthermore, among adults with PHT, higher prevalence, adjusted odds ratios, and population attributable risk percent of having >= 1, >= 2, and >= 3 CVD risk factors were more likely to be found among people with high normal blood pressure (130-139/85-89 mm Hg) compared with their counterparts with normal blood pressure (120-129/80-84 mm Hg). Conclusions: Clustering of CVD risk factors is common among Chinese adults with PHT, especially with high normal blood pressure. Global lifestyle modification would be a very important nonpharmaceutical therapy to reduce the increasing burden of CVD in China.