Hypertension is a major risk factor for cardiovascular disease in Chinese and Japanese with a low to moderate serum cholesterol level. The prevalence of hypertension is diverse in Chinese populations with different geographic region, lifestyles and cultures. The same diversity was observed in Japan in the past, but recently the regional difference has become smaller. The large decline in stroke mortality in Japan was followed by a reduction in the prevalence of hypertension and the lowering level of blood pressure. This is partly explained by various community-based hypertension control programmes. Chinese populations are now showing similar patterns as those observed in Japan. These populations still have high proportions of undetected hypertensives and untreated patients in China. In both Chinese and Japanese, high salt consumption is one of the most important risk factors for hypertension. In addition to this, the increase in body weight, smoking and alcohol consumption in Chinese people seems to be the major factors for the increasing trends in hypertension. Control of hypertension and lowering blood pressure in the population level should be the important strategies for the prevention of cardiovascular disease in Chinese and Japanese.