Background: Individuals with a systolic BP of 120 to 139 mmHg or a diastolic BP of 80 to 89 mmHg should be considered as pre-hypertensive. however limited evidence exists on whether the early drug intervention is needed according to identification of other cardiovascular risk factors except diabetes. Aortic pulse wave velocity (PWV) as an index of aortic stiffening is known recently as a new predictor for future cardiovascular events. We examined the relation between PWV and blood pressure response during exercise in the patients with pre-hypertension, because exaggerated blood pressure response during exercise even in asymptomatic normotensive individuals is associated with significant increased long-term risk of hypertension. Methods and Results: 61 consecutive patients with pre-hypertension were monitored during symptom-limited incremental exercise testing with treadmill. Cuff blood pressure was measured every minute during exercise testing with automatic indirect manometer. Although there were no significant differences in diastolic blood pressure at rest and at the peak exercise between the patients with high PWV (���20% higher than age-matched average value, n=27) and those with low PWV(<20% than average value, n=34), the former reached a higher systolic blood pressure at peak exercise (188.7짹28.7 versus 170.0짹25.3 mmHg, P=0.023). However, there were no differences in the age, sex, total cholesterol, and glucose between two groups. Conclusion: Among the patients with high normal office blood pressure or pre-hypertension in our study, we found that those with high PWV had significantly higher systolic blood pressure during exercise than those without high PWV. This suggests strongly that a high PWV in pre-hypertension is associated with greater likelihood of developing hypertensive complications providing obtainable information on the need to proceed with earlier drug intervention.