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Cardiovascular diseases represent the most common cause of death in the English-speaking Caribbean, and hypertension represents the most important predisposing condition. However, direct between-country comparative studies in the Caribbean have not previously been undertaken.To obtain estimates of hypertension prevalence, awareness, treatment and control in three countries in the Caribbean.Population-based samples of adults aged 25–74 years in St Lucia, Barbados and Jamaica were surveyed regarding their cardiovascular health and their blood pressures were measured using a highly standardized protocol. A reference site was available from a collaborative study among blacks in metropolitan Chicago, Illinois, USA.At the 160/95 mmHg threshold, age-adjusted hypertension prevalence estimates for Jamaica, St Lucia and Barbados were 17.5, 18.3 and 21.5%, respectively, and 24.7, 26.9 and 27.9%, respectively, at the 140/90 mmHg threshold. The corresponding estimate for the Chicago site at the 140/90 mmHg threshold was 33.2%. The gradient in prevalence resembled the gradient in body mass index (25.7 kg/m2 in Jamaica to 29.3 kg/m2 in the USA). At the 160/95 mmHg threshold, the proportion of all hypertensives who were aware of their disease, pharmacologically treated and controlled was highest in Barbados (90, 85 and 72%, respectively) and lowest in St Lucia (74, 59 and 35%, respectively). Men, particularly those aged less than 55 years, were less likely to have their hypertension treated and controlled.Compared with estimates from earlier independent surveys, considerable progress has been made in hypertension detection and control in these countries, which should lead to sizable reductions in the burden of cardiovascular disease.