This study was designed to investigate the current prevalence of hyperhomocysteinemia (Hhcy) and its association with hypertension in rural adults of Northeast China. A cross-sectional study was performed in subjects aged⩾35 years in a general Chinese population. Demographic data, laboratory examination of traditional cardiovascular risk factors and self-reported information on lifestyle factors, such as physical activities, current smoking and drinking status, dietary habits and familial factors were collected by trained personnel. A total of 7130 participants (3317 men and 3813 women) were included in this study and the mean Hhcy level of the whole population was 17.39±12.34 mmol l(-1), which was 20.99±14.83 mmol l(-1) in males and 14.19±8.51 mmol l(-1) in females, respectively. Prevalence of Hhcy in total population was 41.3%. Stratified by gender, the prevalence of Hhcy was higher in males than in females (59.0 vs 25.8%, P<0.05). After adjustment for conventional risk factors including age, salt intake, smoking, body mass index, diabetes, dyslipidemia, activity time and family history, multiple logistic regression analysis showed that Hhcy was independently associated with the risk of hypertension in males (odds ratio (OR)=1.501, 95% confidence interval (CI): 1.012-2.227; P<0.001), but not in females in this population (OR=1.182; 95% CI, 0.993-1.407; P=0.060). In conclusion, a high prevalence of Hhcy in the general adult population of rural northeast China was detected and Hhcy may be a risk factor for hypertension, particularly in males.