Background/Aims: Hei Yi (meaning black worship and black dress) Zhuang is the most conservative group among the 43 ethnic subgroups of Zhuang in China due to its unique culture and customs. The prevalence of hypertension in this population has not been well defined. Therefore, the present study was undertaken to compare the effects of the demographic characteristics, health-related behaviors and lifestyle factors on the prevalence of hypertension in the middle-aged and elderly of the Guangxi Hei Yi Zhuang and Han populations. Methods:A total of 657 people of Hei Yi Zhuang aged 40 and over were randomly selected from 7 villages in Napo County of China. Information on the demographic characteristics, health-related behaviors and lifestyle factors was collected by questionnaire. Blood pressure, height, weight, waist circumference, serum lipid and apolipoprotein levels were measured, and body mass index (BMI) was calculated as a measure of weight relative to height. The results were compared with those of 520 Han who live in the same district. Results: The prevalence of hypertension and isolated systolic hypertension in Hei Yi Zhuang was significantly higher than in Han (32.9 vs. 24.6%, p < 0.01, and 16.7 vs. 5.2%, p < 0.001, respectively). The systolic blood pressure levels and pulse pressure in Hei Yi Zhuang were also significantly higher than in Han (129 ± 20.1 vs. 125.8 ± 17.4 mm Hg, p < 0.01, and 51.5 ± 16.1 vs. 47.1 ± 12.0 mm Hg, p < 0.01, respectively). The prevalence of hypertension was positively correlated with triglycerides, male, age, and alcohol consumption in Hei Yi Zhuang, whereas it was positively correlated with total cholesterol, male, age, alcohol consumption and BMI in Han. The rates of awareness, treatment and control in Hei Yi Zhuang and Han are 7.9 vs. 19.5%, 4.2 vs. 13.3% and 1.4 vs. 9.4% (p < 0.01 for all), respectively. Conclusion: The current study reveals a significant difference in the prevalence of hypertension, blood pressure levels, and the relative factors between the Hei Yi Zhuang and Han ethnic groups, which may have been due to differences in geographical characteristics, lifestyle, sodium intake, education levels, and even genetic factors.