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Prehypertension is a rising public health problem in India. Prehypertension is a precursor of clinical hypertension and is associated with increased risk of cardiovascular disease. The present study describes the prevalence of pre-hypertension and associated risk factors in a rural population of Digwal, Telangana, India.As part of Arogya Seva Initiative of Piramal Swasthya, Door-to-door screening for hypertension and diabetes was carried out from February to May 2017 in 34 villages around Digwal, Telangana using a standard questionnaire and physical measurements. Pre-hypertension was defined as systolic blood pressure (BP) of 120–139 mmHg and diastolic BP of 80–89 mmHg according to the JNC7 (Seventh Report of the Joint National Committee) guidelines.A total of 22,273 individuals aged ≥30 years were screened. Almost 65% of those screened were aged between 30–49 years and 52.8% were females. The prevalence of pre-hypertension was 47.5% (50.7% in males and 45% in females) and hypertension was 29.2% (31.7% in males and 27.6% in females). Average age, proportion of male gender, being overweight or obese, higher waist circumference, impaired glucose levels, nicotine and alcohol use were significantly higher among individuals with pre-hypertension compared to the normal BP group (p < 0.05).The prevalence of pre-hypertension was highly prevalent in this population. Knowledge about pre-hypertension, associated risk factors, health risks, benefits of regular follow-up and lifestyle modification should be aggressively delivered in the community. Government initiatives should focus more on preventive interventions at the community level to manage this rising disease burden.