BACKGROUND: Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases. OBJECTIVE: This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania. DESIGN: A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants. RESULTS: Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%. CONCLUSION: By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension.