Abstract: Objective To explore the association between the high-sensitivity C-reactive protein (hsCRP) to albumin ratio (hsCRP/ALB, CAR) and the development of new-onset hypertension. Methods The data of Kailuan cohort were used for retrospective analysis. A total of 26 418 individuals who had no hypertension during health examination in 2010-2011 and with complete data of hsCRP and albumin were selected as the observation cohort. After excluding 1 425 participants who were positive for hepatitis B, with hsCRP＞20 mg/L, or albumin ＜35 g/L, or did not take the physical examination during the follow-up, 17 766 participants were included in the final analysis. Participants were divided into four groups based on the quartile of CAR values: 1st quartile group (CAR≤0.011), 2nd quartile group (CAR＞0.011-0.022), 3rd quartile group (CAR＞0.022-0.050), and 4th quartile group (CAR＞0.050). Follow-up began at the time of the initial health examination, and the endpoint was the occurrence of new-onset hypertension. A multivariate Cox regression model was used to analyze the association between CAR and the risk of new-onset hypertension. Results A total of 17 766 participants were included, with an average follow-up of (6.69±2.58) years, and 6 175 cases of new-onset hypertension were recorded. In the 1st, 2nd, 3rd, and 4th quartile group, the number of new hypertension cases was 1 277, 1 504, 1 667, and 1 727, respectively, the incidence density (per 1 000 person-years) was 42.66, 48.99, 56.76, and 59.76, respectively, and the cumulative incidence rate was 35.12%, 37.26%, 43.23%, and 45.65%, respectively. Cox regression analysis showed that after adjusting for confounding factors, compared to the 1st quartile group, the hazard ratio (HR) for new-onset hypertension in the 4th quartile group was 1.22 (95%CI: 1.14-1.32). Stratification analysis showed that the HR was 1.20 (95%CI: 1.11-1.30) and 1.55 (95%CI: 1.30-1.84) in participants aged ≤60 years and ＞60 years, 1.19 (95%CI: 1.09-1.29) and 1.27 (95%CI: 1.09-1.50) in the males and females, 1.23 (95%CI: 1.15-1.33) and 1.04 (95%CI: 0.71-1.53) in the individuals with salt intake ≥6 g/d and ＜6 g/d. Conclusion Higher CAR may be associated with an increased risk of developing hypertension.