Objective: Describe the change in the prevalence of hypertension (HTA) and cardiometabolic risk factors (RF's) in PURE Colombia cohort during the period 2005-2021. Design and method: Design: Cohort study. Methods: 7552 adults participants of the PURE Colombia cohort from 11 departments (Atlántico, Bolívar, Caldas, Casanare, Cauca, Cesar, Cundinamarca, Nariño, Quindío, Santander, Tolima) followed up for a mean of 13 years (SD 2.3). A descriptive analysis was used to document the changes in prevalence of HTA and associated RF's such as body mass index (BMI), waist-hip ratio (WHR), and level of physical activity (PA) in the follow-up period 2005-2021. PA is divided into three levels and measured in metabolic equivalent of task (METs). Results: Of the participants, 64% were women, with a mean age at follow-up of 65 years (SD 9.7). Overall, the prevalence of HTA increased by 12% (p<0.001), reaching values of 47.5% and 51.5% in men and women, respectively. In addition, there was an increase in obesity prevalence (BMI > 30) in both men and women (increases of 6.8 and 5.8 %, respectively, p<0.001,), reaching an overall prevalence of 25% in the population. Consist with this, WHR increased from 0.93 to 0.95 in men (p<0.001) and from 0.86 to 0.89 in women (p<0.001Finally, we found that there was a global increase in the number of people with a low level of PA (17.7 to 43.8% p<0.001). Conclusions: We observed a significant increase in the prevalence of cardiometabolic RF's and HTA after over a decade of follow-up of adults in a middle-income American country. Increases in modifiable RF's such as higher BMI and WHR and reduced numbers with adequate PA concurrent with the trends in HTA suggest a positive relationship between them and reaffirm the necessity to emphasize strategies focused on potentially modifiable lifestyle RF's.