American College of Cardiology/American Heart Association recently updated their guidelines for hypertension, and lowered the threshold of normal blood pressure (BP). However, the validity of the updated guidelines remains controversial. We investigated the relation between the revised BP classification and carotid intima-media thickness, using a community-based cohort. We examined 1,241 subjects who underwent health check-ups at our institute. They were divided into 3 groups based on their BP levels: normal blood pressure (sBP <130 mm Hg and dBP <80 mm Hg, n = 556); stage 1 hypertension (130 mm Hg ≤sBP <140 mm Hg or 80 mm Hg ≤ dBP <90 mm Hg, n = 236); and stage 2 hypertension (sBP ≥140 mm Hg or dBP ≥90 mm Hg, including subjects prescribed with antihypertensive medications, n = 449). With an increase in BP, increase in the mean age, proportion of males, and prevalence of CVD risk factors was seen. The prevalence of carotid plaque, defined as intima-media thickness ≥1.1 mm, also increased with increase in BP. After adjustment with covariates, higher BP was seen to be associated with carotid plaque presence. Atherosclerotic changes are present in stage 1 hypertension even in the healthy population, suggesting the importance of aggressive antihypertensive treatment based on the updated American College of Cardiology/American Heart Association guidelines.