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To assess the trends in blood pressure (BP) levels and the control of hypertension in eastern and south-western Finland during 1982–2002.Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002.The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland.Stratified random samples of men and women aged 25–64 years were selected from the national population register. The total number of participants was 29 127.Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), the prevalence and control of hypertension. The distribution of all subjects with no antihypertensive drug treatment in 2002 according to the modified risk stratification scheme introduced in 2003 European Society of Hypertension–European Society of Cardiology guidelines.Mean SBP and DBP and the prevalence of hypertension decreased significantly in all areas. The proportion of treated hypertensive subjects with adequately controlled BP (SBP < 140 mmHg and DBP < 90 mmHg) increased from 13.7 to 33.3% in men (P < 0.001) and from 11.4 to 32.0% in women (P < 0.001). The unsatisfactory treatment of hypertension was mainly a result of the lack of control of high SBP. According to the 2003 guidelines, 35.9% of the entire population currently not on antihypertensive drug treatment should have been prescribed such treatment within a year.Hypertension care has improved significantly in Finland during 1982–2002. However, the difference between the actual situation at the population level and the treatment goals presented by the hypertension guidelines remains vast.