BACKGROUND: Blood pressure control is of great importance in the prevention of cardiovascular events. AIM: To determine the prevalence, awareness, treatment and control of hypertension in healthy unrelated male-female pairs of European regions. METHODS: The dietary habit profile in European communities with different risk of myocardial infarction: the impact of migration as a model of gene-environment interaction (IMMIDIET) project was a cross-sectional study to investigate differences in the distribution of cardiovascular risk factors and dietary habits in healthy unrelated male-female pairs married or living together in European regions. Eight hundred and two unrelated male-female pairs were randomly recruited in Abruzzo (Italy), Limburg (Belgium) and south-west London (England). Blood pressure was measured using an automated device. Hypertension was defined as systolic blood pressure of at least 140 mmHg or diastolic blood pressure of at least 90 mmHg or current antihypertensive treatment. RESULTS: Overall, 24.4% of the population was hypertensive; among them, one-third was on antihypertensive treatment, but a significant proportion (56%) was unaware of the high blood pressure levels. Men were more often hypertensive than women (29.4 vs. 19.5%, P < 0.0001). Women were more often treated than men (49.8 vs. 28.9%, P < 0.0001). Women from south-west London showed blood pressure levels lower than those from Abruzzo and Limburg (P < 0.001 for both, adjusted for age, BMI and social status). No difference among countries was found in blood pressure levels in men. The adjusted prevalence of hypertension was 20.8% in south-west London, 23.6% in Limburg and 28.87% in Abruzzo (Abruzzo vs. south-west London P = 0.005). The prevalence of antihypertensive treatment was 43.5, 42.5 and 32.1% in Abruzzo, Limburg and south-west London, respectively. Out of those treated for hypertension, 42, 43 and 47.7% in Abruzzo, Limburg and south-west London, respectively, were well controlled. CONCLUSION: In communities of healthy unrelated male-female pairs from three different European regions, more than half of hypertensive patients appeared to have blood pressure levels not at target values. Interventions are required to optimize the use and effectiveness of antihypertensive drug therapy in these patients.