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Background & objectives: Hypertension is a major risk factor for cardiovascular and renal diseases. In PR China, the prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The objective of this study was therefore to estimate the prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment, and control in the general rural adult population in northeast China. Methods: During 2005-2007, in Liaoning province of northeast China a probability proportional to size sampling method was used to select a nationally representative sample. A total of 45,925 adults (aged >35 yr) were examined. Three blood pressure measurements were obtained by trained observers using a standardized sphygmomanometer after a 5-minute sitting rest. Information on history of hypertension and use of antihypertensive medications was obtained. Hypertension was defined as a mean systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg, and/or use of antihypertensive medications. Results: Overall, 37.8 per cent of the rural adult population from northeast China aged 35 to 85 yr had hypertension. Among hypertensives, only 29.5 per cent were aware of their high blood pressure, 20.2 per cent were taking antihypertension medication and 0.9 per cent achieved blood pressure control (<140/90 mm Hg). Of all subjects, 43.9 per cent did not think that high blood pressure would endanger their lives. The reasons why not taking antihypertensive medication in hypertensives aware of having hypertension was 40.2 per cent for their lack of knowledge about the fatalness of hypertension and 32.3 per cent for financial straits. Interpretation & conclusion: Our results indicated that hypertension is highly prevalent in rural areas of northeast China. The percentages of those with hypertension who were aware, treated and controlled were unacceptably low. These results underscore the urgent need to take comprehensive controlling measures and improve the awareness of hypertension at the same time to control hypertension in rural population of Liaoning province. [ABSTRACT FROM AUTHOR]