Fat distribution has been shown to be a strong correlate of hypertension, independent of general obesity. However, population-based studies are lacking on the association of regional fat depots with hypertension. The present study is a cross-sectional analysis of 2969 individuals in the Health, Aging and Body Composition Study (915 men of white ethnicity and 535 of African American; and 833 women of white ethnicity and 686 of African American) who were 70 to 79 years of age. Fat depots were measured by computed tomography. The prevalence of hypertension was 57%. Among those with hypertension, 70% reported antihypertensive treatment. In logistic regression analyses, visceral fat was strongly associated with hypertension (odds ratios for each standard deviation increase in the area of visceral fat: 1.28, P < .0001) after adjustment for age, sex, ethnicity, site, height, smoking status, pack-years of smoking, alcohol consumption status, amount of alcohol consumption, and physical activity. Moreover, the association was the strongest in individuals with the least amount of total body fat. Besides visceral fat, subcutaneous fat and thigh intermuscular fat were also associated with hypertension in African Americans. Larger amounts of visceral fat may indicate a high risk of hypertension in older adults, especially in lean individuals. © 2004 American Journal of Hypertension, Ltd.