Objective To assess rates and determinants of prevalence, awareness, treatment and control of hypertension in rural north-western China. Methods Adults were recruited from five surveillance areas in Gansu Province using a three-stage cluster sampling plan. A combination of household and community–based surveys was employed and two methods of surveillance (questionnaire and physical measurement) were undertaken. Results A total of 3000 subjects were included; 1100 (36.7%) had hypertension. Hypertension was associated with older age, lower educational levels and being overweight or obese. Only 407 (37%) subjects with hypertension were aware of their condition. Multiple logistic regression showed significant correlations between hypertension awareness and age, obesity and central obesity. Antihypertensive treatment was received by 31.2% of participants with hypertension. Obesity, smoking and older age were associated with treatment. Blood pressure was controlled in 18.1% of participants receiving antihypertensive treatment and in 5.6% of subjects with hypertension overall. Conclusion In conclusion, prevalence of hypertension is rapidly increasing in rural north-western China. Rates of awareness and treatment of hypertension remain low and blood pressure is poorly controlled.