Objective: To investigate the prevalence of prehypertensive status as well as the differences of cardiovascular risk factors in prehypertension patients aged 40-79 years old in urban and rural areas in Dongying City. Methods: By cluster sampling method, subjects aged 40-79 years old in two urban areas and two rural areas in Dongying City were studied by questionnaires, physical examinations and blood chemistry tests. Physical examinations included height, weight, BMI and BP. Overnight fasting blood sample were collected to detect fasting glucose, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, and homocysteine. Results: The number of patients with prehypertension is 1 287 in the all 4 109 people. The overall prevalence of prehypertensive status was 31.32%, including 582 (31.34%) male and 705 (31.31%) female, which showed no statistical differences (χ2=0.0006, P>0.05). The prevalence of prehypertensive status in urban and rural areas were 41.63% and 20.32%, respectively. And it showed a significant difference between these two groups (χ2=216.620, P<0.001). When combining the risk factors (one factor each time) with prehypertension, homocysteine is the risk factor that showed the highest prevalence (76.38%). The prehypertensive population accompanied with homocysteine was higher in rural (80.69%) than in urban (74.41%), there was statistically significant difference (χ2=6.0739, P<0.05). The prehypertensive population accompanied with smoke was higher in urban (36.24%) than in rural (27.97%), there was statistically significant difference (χ2=8.491, P<0.05). Among female populations, the prevalence was higher in urban areas (21.76%), as 2.35 times as that in rural areas (9.25%), there was statistically significant difference (χ2=16.5028, P<0.05). The prevalence of prehypertension associated with obesity was higher in urban residents (23.67%) than that in rural residents (17.57%), there was statistically significant difference(χ2=6.0491, P<0.05); urban men (24.44%) were more than rural men (12.99%), the difference was statistically significant (χ2=9.7466, P<0.05). In prehypertensive population associated with dyslipidemia or abnormal carbohydrate metabolism, there were no differences between urban area and rural area. Conclusion: Hyperhomocysteinemia is the most commonly seen risk factor for prehypertensive population, followed by dyslipidemia. Prehypertensive population combined with hyperhomocysteinemia in rural area should be taken into account with earlier intervention. The prevalence of prehypertension is closely related to the living habits. Therefore the prevention of prehypertension should be combined with urban and rural prehypertension epidemiological characteristics of risk factors, making the targeted prevention and control strategies.