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Data on hypertension prevalence, awareness, treatment and control are sparse in the Middle East especially in the different socio-demographic characteristics (age, sex, community location, education) and comorbid status like diabetes and cardiovascular disease. We report the prevalence, awareness, treatment, and control of hypertension across four Middle Eastern countries (Iran, Occupied Palestinian Territory (OPT), Saudi Arabia, and United Arab Emirates (UAE)), using a standardized and uniform method.The Prospective Urban Rural Epidemiology (PURE) study enrolled 10,516 participants, from 52 urban and 35 rural communities from four countries in the Middle East. Hypertension is defined as blood pressure > = 140/90 mmHg using an automated digital device. Those who reported knowing they had hypertension or using blood pressure lowering medications among those with hypertension were considered as being aware. Control was defined as those on blood pressure lowering medications and blood pressure lower than 140/90 mmHg among the hypertensives.Among participants, 33% had hypertension; of these 49% were aware, 47% were treated with. only 19% being controlled. Prevalence, awareness, treatment, and control of blood pressure were higher among women and older (50–69 years) participants compared with men and younger individuals (30–49 years). (P < 0.0001 for all). The prevalence of hypertension was highest in UAE (52%) and lowest in Iran (28%). Awareness, treatment, and control of hypertension were significantly higher in the OPT and Saudi Arabia. The prevalence was higher in rural communities, however, awareness, treatment and control was significantly higher in the urban. Only 17% received two or more blood pressure lowering medications, and this was significantly more in women, older age and in those diabetic or with CVD. Table.Findings from this study indicate the need for improvements in hypertension diagnosis and treatment in the Middle East, especially in rural communities, men and younger individuals.