This study determined the cost-effectiveness of one- versus two-stage hypertension screening at small to medium-sized blue collar, multicultural work sites using voluntary health organization and public health unit personnel. Workers with diastolic blood pressure (DBP) ≥90 mm Hg were randomly allocated to one- or two-stage screening with differing physician referral protocols based on blood pressure level and treatment status. At first screening of 7856 workers, 12.5% had DBP ≥90 mm Hg or <90 and on medication with 64% aware of having hypertension, 42% on medication and 30% controlled (DBP <90 mm Hg). One year later, there were no significant differences in effects or cost-effectiveness between groups. Both had significant DBP decrease (8.5 mm Hg), 54% had seen a physician within the recommended time, and 50% were controlled on medication or any treatment. One-stage screening, being easier to implement, is the preferred option.