Objective To compare the difference in the prevalence of hypertension diagnosed with the 2017 American hypertension diagnostic criteria (American standard) and the Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition, Chinese standard) in the general population. Methods The cluster stratified random sampling method was adopted. The population samples were collected from the population database of physical examination between 2015 and 2019 in Shanghai Sixth People’s Hospital and were stratified by every 10 years. Twenty people including 10 males and 10 females were randomly selected from every year, which was defined as one layer. The information of investigation included medical history investigation, height, weight, blood pressure measurement, blood biochemical index detection, etc. Both the items and information of the physical examination adopted unified and standardized testing methods. According to the definition of hypertension in China standard [≥140/90 mmHg (1 mmHg=0.133 kPa) or taking antihypertensive drugs right now]and in American standard(≥130/80 mmHg or taking antihypertensive drugs right now), the prevalence of hypertension in people in different genders and ages were calculated, respectively. Results The population prevalence of hypertension based on Chinese standard was 27.3%(29.0% in male and 25.7% in female); the population prevalence of hypertension based on American standard was 55.8% (65.3% in men and 46.3% in women); the systolic blood pressure showed a linear increase with age, while the diastolic blood pressure showed an inverted“U” distribution with age; the prevalence of hypertension based on both definitions increased with age in 6 age groups, which were 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years. Furthermore, the age groups of 50-59 and 60-69 showed the largest differences in two diagnostic criteria, with an increase of 37.0% and 39.0%, respectively. The prevalence of hypertension in male was higher than female in most age groups except the groups of 60-69 and 70-79 years in Chinese standard and the group of 70-79 years in American standard (all P<0.05). The two diagnostic criteria led to large difference in the diagnostic rate of hypertension in male. Conclusions According to 2017 American standard, the prevalence of Chinese young and middle-aged people diagnosed as hypertension increased significantly compared to Chinese standard of 2018. Therefore, more attention should be given to this group, and the lifestyle and medical interventions should be carried out early to reduce the risk of cardiovascular and cerebrovascular diseases.