Abstract: Objective To study the relationships between neck circumference and cardiovascular risk factors in residents with hypertension and prehypertension. Methods A total of 3560 residents（aged ≥40 years） in a Dalian community diagnosed with hypertension and prehypertension were enrolled in "The Risk Evaluation of Cancers in Chinese Diabetic Individuals" from July 2014 to December 2014. The neck circumference, waist circumference（WC）, height, weight, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, fasting plasma glucose（FPG）, 2 h-postprandial plasma glucose（2 hPPG）, glycosylated hemoglobin（HbA1 c）, total cholesterol（TC）, triglycerides（TG）, low density lipoprotein-cholesterol（LDL-C） and high density lipoprotein-cholesterol（HDL-C） were measured and recorded in a questionnaire along with other basic information. Results The neck circumference was higher in men （38.88±2.94） cm than in women （34.81±2.56） cm. In both men and women, neck circumference was associated with WC, BMI, SBP, DBP, FPG, 2 hPPG, HbA1 c, TG and HDL-C（all P＜0.05）. After adjusted for both BMI and WC, the neck circumference increased with diabetes in men and with hypertension, diabetes and metabolic syndrome in women（all P＜0.05）. For more than three cardiovascular risk factors, the area under curve of neck circumference was 0.719 for men and 0.646 for women. The neck circumference of 37.9 cm for men and 33.6 cm for women were the best cutoff points for diagnosing the subjects with more than three cardiovascular risk factors. Conclusions Neck circumference is associated with cardiovascular risk factors in patients with hypertension and prehypertension. The neck circumference of 37.9 cm for men and 33.6 cm for women are the best cutoff points for determining subjects with more than three cardiovascular risk factors.