BACKGROUND Polycystic ovary syndrome (PCOS) is a common disorder with metabolic complications, yet the prevalence of hypertension is unclear. We aim to assess hypertension prevalence and the impact of obesity in women reporting PCOS compared to those not reporting PCOS. METHODS This is a cross-sectional analysis of data from a large longitudinal study, the Australian Longitudinal Study on Women s Health (ALSWH). Women from the general community were randomly selected from the national health insurance database. Standardized data collection occurred at 6 survey time points. Data from Survey 4 in 2006 (n = 8,612, age: 28-33 years) were examined for this study. The main outcome measures studied were self-reported PCOS and hypertension. RESULTS Reported PCOS prevalence was 5.8 (95 confidence interval (CI): 5.3 -6.4 ). Women with PCOS had higher body mass index (BMI). Hypertension prevalence was 5.5 (95 CI: 3.3-7.7) in women reporting PCOS and 2.0 (95 CI: 1.6-2.3) in women not reporting PCOS (P <0.001). Hypertension was associated with BMI (odds ratio: 1.07, 95 CI: 1.05-1.10, P <0.001) with a trend towards an association with PCOS (P = 0.09). On subgroup analysis, hypertension was not associated with BMI in women reporting PCOS but was associated in those not reporting PCOS. CONCLUSIONS In this large community-based cohort, we note increased prevalence of hypertension and higher BMI in young women reporting PCOS. BMI association with hypertension appeared clear in women not reporting PCOS. Yet in women with PCOS, hypertension appeared to not be associated with BMI, akin to observations on diabetes risk in PCOS, suggesting that metabolic abnormalities in PCOS may be independent of BMI.