Background Non Communicable Diseases (NCDs) including CVD, cancer, Diabetes Mellitus (DM) and CRD are the leading cause of premature mortality globally and in the low- and –middle income countries. In 2012, 68% of all deaths were secondary to NCDs leading to approximately 38 million deaths per year and 80% of NCD deaths occurred in LMIC. CVD is the leading cause of death contributing 17.5 million deaths annually. High blood pressure is the key risk factor for CVD and 58% of CVDs are attributable to high blood pressure. DM is another key risk factor for CVD causing 1.5 million deaths annually. Prevalence of both HTN and DM is rising in LMIC like Tanzania. Despite the increase, there is lack of data on burden of HTN and DM due to lack of monitoring and surveillance of status of NCDs, the information which is vital in setting targets and monitor progress. Objectives To determine the prevalence of hypertension and diabetes and to assess the risk factors for HTN and DM among people aged 50 years and above in Rombo district, Kilimanjaro, Northern Tanzania. Methodology This was a secondary data analysis of a cross-section study that was conducted from April to June 2015 among people aged 50 years and above in Rombo district. Multi-stage random sampling method was used to get the study participants. Questionnaires were used to collect key information during a face to face interview followed by the measurement of the BP, blood glucose level, height, and weight and waist circumference. Data from the parent study was extracted and analysis included participants with both BP and diabetes results/data. SPSS was used for analysis. Results 600 participants (311 men and 289 female) were enrolled in the study. 289 were aged between 50-69 years and 211 were aged 70 years and older with the mean age of 1.35 (SD±0.478). Overall prevalence of hypertension was 61% (n=366) with women having a slight higher prevalence (32.7%) in comparison to men (28.3%). Prevalence of diabetes was 2.3% (n=14) and 2.77% and 1.93% between female and male respectively. Age, sex, education level, cigarette smoking and use of heroine were factors found to associate with hypertension while only alcohol intake was found to associate with diabetes. xi Conclusion Prevalence of hypertension was high while diabetes was low among people aged 50 years and older in Rombo district. There is a need to promote health education, community-based interventions targeting risk factors for primary prevention, regular health screening especially in the rural areas and medical treatment should be given to those who have been identified to be diabetic or hypertensive to prevent further complications. Keywords: Hypertension prevalence, diabetes prevalence, risk factors