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: Background: Pre-hypertension is known as the precursor of hypertension. We could prevent or delay hypertension by controlling pre-hypertension. Objectives: In this study, we investigated the prevalence of pre-hypertension and its risk factors in an Iranian population, East of Iran, in 2014. Patients and Methods: This cross-sectional study was conducted on 1280 subjects living in Birjand, East of Iran in 2014. After explaining about the project, a questionnaire containing demographic characteristics and clinical backgrounds was filled out by all subjects. Participants were classified as pre-hypertension (PHTN) if systolic blood pressure was 120 - 139 mmHg or if diastolic blood pressure was 80 - 89 mmHg. Data were analyzed by chi-square test and multiple logistic regression using SPSS (version 22). P < 0.05 was considered as statistically significant. Results: Among 1286 participants, 21.4% had pre-hypertension. Results showed that pre-hypertension, diabetes mellitus (DM) and smoking were more prevalent among men than women (P < 0.001), while prevalence of dyslipidemia was more observed in women (P < 0.001). In addition, the risk of pre-hypertension was more in men (OR = 2.9), overweight (OR = 3.7), and obese (OR = 5.6) subjects. Smoking cigarette showed a protective effect (OR = 0.4). Conclusions: Pre-hypertension was more prevalent among men and obese subjects. Since pre-hypertension progresses to hypertension and increases the risk of cardiovascular disease, it needs more attention by public health policy makers to change people’s lifestyle.