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: To determine the prevalence of hypertension and its correlates among pygmy and Bantu dwellers in rural and urban environments of southern Cameroon.: In this cross-sectional cluster sampling survey, we compared 100 traditional pygmies (TP) living in forest (Lolodorf) under hunter-gatherer subsistence mode and 100 traditional Bantus (TB) living in Bidjouka village closed to Lolodorf, to 100 contemporary pygmies (CP) and 100 contemporary Bantus (CB) both living in the same urban environment in Kribi. Trained observers recorded in each participant lifestyle and socio-demographic data, height, weight, body mass index (BMI), waist circumference and blood pressure (BP). Brachial systolic BP (SBP) and diastolic BP (DBP) were measured in triplicate using an automatic sphygmomanometer (Omron 705CP).Hypertension was considered for SBP/DBP≥140/90 mmHg.Pygmies were younger than Bantus: mean age = 38 ± 16 vs 45 ± 17years,p = 0.0001. Overweight/obesity (23.5% vs 42%), abdominal obesity (1% vs 16%) and alcohol consumption (48% vs 59.5%) rates were lower in pygmies than in Bantus (all p < 0.01). By contrast, smoking rate was greater in pygmies than in Bantus (47.5% vs 35%, p = 0.015). Age-adjusted prevalence of hypertension was lower in pygmies than Bantus globally (7.5%vs21.5% p = 0.0001), and in rural and urban settings: 4%vs19% and 11%vs24 %, respectively, both p < 0.01). In pygmies taken separately, the age-adjusted prevalence of hypertension was lower in TP than in CP (4%vs11%). Multivariate logistic regression analysis performed in the whole study population revealed that hypertension was independently associated with urban environment (OR = 2.15, 95%CI:1.14–4.05), Bantu status (OR = 2.17, 95%CI:1.09–4.34), age ≥50 years (OR = 2.15, 95%CI:1.14–4.05), and abdominal obesity (OR = 0.20 95%CI:0.09–0.46) (all p < 0.05). In pygmies taken separately, age ≥50 years (OR = 3.83, CI95%:1.33–11.36) and urban environment (OR = 3.33, CI95%: 1.04–11.11)(both p < 0.05) emerged as independent determinants of hypertension.This study demonstrates that hunter-gatherer subsistence mode is associated with lower prevalence of hypertension as observed in TP. Hypertension is more common in Bantus and CP, and driven mostly by their westernized lifestyle and the growing urbanization of rural area.