OBJECTIVES: Hypertension is a leading global risk factor for the burden of cardiovascular disease. Data about changes in hypertension control are important to set intervention priorities. We conducted a systematic review and meta-analysis of epidemiological studies to determine the control of hypertension in Spain over the last decade. METHODS: A search of PubMed/MEDLINE, SCOPUS and IME was performed for epidemiological studies  conducted in Spain (since 2000) with data on control rates for hypertension. The primary outcome was the prevalence of uncontrolled hypertension defined as the percentage of patients having systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. For populations at risk (e.g. patients with diabetes), the definition was SBP ≥ 130 mmHg and/or DBP ≥ 80-85 mmHg. Pooled-prevalence estimates and 95% confidence intervals (95% CI) were determined by random-effects models using the inverse variance method. Heterogeneity was assessed using Cochran's Q and I2 statistics.   RESULTS: Seventy-six studies evaluating 341,632 patients (79% with hypertension) met the inclusion criteria. Among hypertensive patients, the overall pooled-prevalence of uncontrolled hypertension (≥ 140/90 mmHg) was  67.0% (95% CI: 64.1% to 69.9%), but was 87.6% (95% CI: 86.2 to 89.0%) when the most restricted definition (≥ 130/80-85 mmHg) was used for patients at risk. The test for heterogeneity was significant (P<0.001). Using metaregression analyses, we showed that the prevalence of uncontrolled hypertension did not change significantly over time, but the percentage of patients receiving at least two antihypertensive drugs increased (P=0.032, and 0.001). CONCLUSIONS: In Spain, the control of hypertension is far from optimum and does not appear to have improved in recent years despite the increased intensity of therapy. Patients at risk with comorbidities appear to be controlled worse.