Objective To determine the incidence of hypertension and its risk factors among rural Chinese adults.

Methods A population-based sample of 24 360 rural Chinese adults aged ≥35 years and free from hypertension at baseline were followed from 2004–2006 to 2008. Incident hypertension was defined as systolic pressure ≥140 mm Hg, diastolic pressure ≥90 mm Hg, or current use of antihypertensive medication.

Results Over a mean of 28 months of follow-up, 29.6% of men and 23.4% of women developed hypertension. The age-adjusted incidence rate was higher in men (12.75 per 100 person-years) than in women (10.04 per 100 person-years). Among men, independent predictors of incident hypertension were baseline age [RR per 5 years: 1.11; 95% CI 1.10 to 1.13], Mongolian ethnicity (RR: 1.09; 95% CI 1.01 to 1.18), use of alcohol, (RR: 1.14; 95% CI 1.06 to 1.23), high income versus low income (RR: 1.11; 95% CI 1.00 to 1.22; RR: 1.11; 95% CI 1.03 to 1.20), prehypertension versus normotension (RR: 1.18; 95% CI 1.08 to 1.28), overweight and obesity (RR: 1.28; 95% CI 1.17 to 1.40), baseline salt intake (RR per one g/day: 1.00; 95% CI 1.00 to 1.01) and family history of hypertension (RR: 1.14; 95% CI 1.03 to 1.27). With the exception of use of alcohol, mean income, low physical activity was shown as risk factors in women; the results were similar for women. The awareness, treatment and control rates for newly developed hypertension were 29.9%, 19.5% and 1.5% respectively.

Conclusions These data indicate that the incidence of hypertension is high among these rural Chinese adults and it is associated with many risk factors. And suggest that most newly developed hypertension cases are not treated. These increases in hypertension are probably related to rapid social changes in our country and may apply to other areas of the developing world. These results call for urgent improvements in hypertension prevention and control programs in rural China.