Abstract: Objective To understand the prevalence and influencing factors of isolated systolic hypertension（ISH） in adults aged 35 to 59 in Fujian Province, and to provide scientific basis for the prevention and treatment of hypertension. Methods A cardiovascular disease screening project was conducted during 2017 to 2020 in Fujian Province. Residents aged 35-75 years were selected in 10 project sites. Among them, those aged 35 to 59 were enrolled in this study. The prevalence of ISH in different characteristic population was analyzed, and the influencing factors were analyzed by multiple logistic regression model. Results Among the 69 321 subjects, 22 018（31.8%） suffered from hypertension, 7 050（10.2% of all subjects, or 32.0% of those with hypertension） had ISH, and the standardized prevalence rate of hypertension and ISH in young and middle-aged adults were 27.1% and 7.3% respectively. Significant differences were observed among different blood pressure types in subjects with different residence, gender, age, education, occupation, family income, smoking, drinking, dyslipidemia, diabetes and obesity（all P＜0.05）. Multiple logistic regression analysis showed that women, older age group and diabetes were associated with a high risk of ISH（all P＜0.05）, high school education and above, annual household income≥50 000 yuan were associated with the low risk of ISH（all P＜0.05）. Conclusions The prevalence of ISH among young and middle-aged adults in Fujian province is not optimistic. The daily monitoring and targeted intervention for ISH should be strengthened for women, older age groups, individuals with low educational level, low income and diabetes.