The prevalence of hypertension has increased in China, and prehypertension frequently progress to hypertension over a couple of years, both has been public health problems. Therefore a cross-sectional epidemiological survey was conducted in order to determine the prevalence of pre-hypertension and associated risk factors in Zhengzhou, middle of China. A total of 4800 community residents aged 18 year and older from 6 communities were screened by a stratified random cluster sampling method. Baseline characteristics of residents were acquired by questionnaire, physical examination, blood and urine biochemical measurement. Prehypertension was defined according to the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Multivariate logistic analysis was used to analyse the risk factors of prehypertension. Prevalence of prehypertension was 30.3% in Zhengzhou adult population, and 36.1% in men and 26.0% in women separately. Prevalence of prehypertension was 27.4% in overweight residents, 32.5% in insulin resistance residents, 36.1% in current smoking residents, and increased dramatically with age. Multivariate logistic regression indicated that age, Body Mass Index (BMI), waist circumference, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) smoking, and brachial-ankle Pulse Wave Velocity (baPWV), were independent risk factors of prehypertension. Prehypertension has been a major public health problem in Zhengzhou, middle China; obesity and insulin resistance have been important risk factors.