Abstract Background In India, a rapid epidemiological transition is occurring as the burden of non communicable chronic diseases is over taking the burden of infectious diseases. Early diagnosis of hypertension (HT) is an important strategy in controlling the disease among younger generations. Many recent studies have highlighted the incidence of hypertension in young children and adolescents. The objective of the present study is to assess the prevalence and determinants influencing hypertension in urban school children in Bettiah, Bihar. Methods: This is a school based cross sectional study, done to estimate the prevalence of hypertension among healthy school children in urban Bettiah. Children between the age of 12-17yrs were included in this study. Demographic data, academic performance as well as dietary pattern were assessed. Students were selected based on purposive sampling method and blood pressure measurements were recorded using a mercurial sphygmomanometer as per WHO criteria. Data collected were analysed using SPSS software . Demographic variables are presented in frequencies.Semi parametric statistical test -Chi-square test was used to find out the association of various risk factors that influenced hypertension among the school children. Results: Prevalence of hypertension was 2.4% and pre hypertension was 4.2% among the urban school children. Family history of hypertension, increased waist-hip ratio, obesity and excessive consumption of fast food are being reported as a major risk factor in the development of childhood hypertension from this study.