BACKGROUND: Pre-hypertension (HTN) and HTN are risk factors for cardiovascular disease (CVD). Despite its importance, HTN is often underestimated and undiagnosed, especially in women. This study was designed to determine the prevalence of pre-HTN and HTN among a large sample of Iranian menopausal women.METHODS: This repeated cross-sectional study was conducted on 1013 menopausal women aged 41 to 85 years in Isfahan, Iran, in the years 2001, 2007, and 2016. The participants were selected through multistage cluster random sampling. Awareness, treatment, and control of HTN were assessed using a validated researcher-made questionnaire. Blood pressure was determined via an arm digital blood pressure monitor.RESULTS: The prevalence of HTN in the years 2001, 2007, and 2016 was 52.6%, 49.0%, and 51.6%, respectively; no significant changes were observed (P > 0.05). The prevalence of pre-HTN in these years was 56.6%, 53.3%, and 42.2%, respectively. In 2001 and 2007, respectively, 28.8% and 50.4% of menopausal women had HTN controlled by medication, and in 2016, 86.6% of women were aware of their disease and 62% of them had controlled HTN (P < 0.001).CONCLUSION: The results showed that HTN and pre-HTN were highly prevalent among Iranian menopausal women and markedly increased with age. Interventional population-based approaches are needed to improve knowledge and efficient practice that may help to lower the risk of HTN and CVD in this at-risk population.