Background: Although prehypertension is associated with an increase in cardiovascular morbidity and mortality, functional and structural vascular remodeling in persons with prehypertension has been incompletely investigated. Methods: We conducted a population-based study of 285 randomly selected healthy men 40 to 49 years who were classified into three groups according to baseline blood pressure. As the parameters of vascular calcification and arterial stiffness with traditional risk factors, carotid intima-media thickness (IMT) by ultrasonography, heart-femoral pulse wave velocity (hfPWV) by an automated device, and aortic calcification by electron beam computed tomographic scan were measured. The aorta calcium scores (ACS) were analyzed as ACS < 100 versus ACS ��� 100, or as log (ACS + 1). Results: Body mass index (BMI), total cholesterol, alcohol intake, and apnea-hypopnea index increased across blood pressure categories (p < 0.05). Carotid IMT (p < 0.001), hfPWV (p < 0.001), and log (ACS + 1) (p = 0.01) also tended to increase. Compared with normotensive subjects, both prehypertension and hypertension were significantly associated with increased carotid IMT (p = 0.003 and p = 0.000) and hfPWV (all p < 0.001) in multivariate linear regression analysis. Prehypertension and hypertension were also significantly associated with increased odds of ACS ��� 100 (adjusted odds ratios [OR] 2.59, 95 % confidence interval [CI] 1.23 to 5.47 and OR 3.29, 95 % CI 1.33 to 8.14). Conclusions: Functional and structural vascular changes are already initiated at the stage of prehypertension, not hypertension.