More than 35 million people in coastal Bangladesh are vulnerable to increasing freshwater salinization. This will continue to affect more people and to a greater extent as climate change projections are realised in this area in the future. However the evidence for health effects of consuming high salinity water is limited. This research examined the association between drinking water salinity and blood pressure in young adults in coastal Bangladesh. We conducted a cross-sectional study during May-June 2014 in a rural coastal sub-district of Bangladesh. Data on blood pressure (BP) and salinity of potable water sources was collected from 253 participants aged 19-25 years. A linear regression method was used to examine the association between water salinity exposure categories and systolic BP (SBP) and diastolic BP (DBP) level. Sixty five percent of the study population were exposed to highly saline drinking water above the Bangladesh standard (600 mg/L and above). Multivariable linear regression analyses identified that compared to the low water salinity exposure category (<600 mg/L), those in the high water salinity category (>600 mg/L), had statistically significantly higher SBP (B 3.46, 95% CI 0.75, 6.17; p = 0.01) and DBP (B 2.77, 95% CI 0.31, 5.24; p = 0.03). Our research shows that elevated salinity in drinking water is associated with higher BP in young coastal populations. Blood pressure is an important risk factor of hypertension and cardiovascular diseases. Given the extent of salinization of freshwater in many low-lying countries including in Bangladesh, and the likely exacerbation related to climate change-induced sea level rise, implementation of preventative strategies through dietary interventions along with promotion of low saline drinking water must be a priority in these settings.