Background and purpose: This study aims to investigate whether changes in lifestyle, added to the antihypertensive treatment, could translate to changes in cardiovascular (CV) morbidity and mortality in hypertensive patients. Methods: Between October 2007 and November 2008, men or women (50-79 years) were enrolled randomly in this study when their BP was 140/ 90-179/ 109 mmHg with a 2-weeks run-in stage firstly. All participants had at least one additional CV risk factor, indicated by a history of stroke, myocardial infarction (MI), etc. Results: 12,245 (90.4%) patients were eligible for our analysis. We assigned them to the lifestyle intervention group (5225) or to control group (7020). In the end of the study, weight loss at least 1 kg of the participants of the intervention group of accounted for 33.2%, control group was 24.9 (P < 0.001). Salt intake more than 6 g of the participants accounted for 29.4% in the intervention group, 38.4% in the control group (P < 0.001). The composite CV events which include non-fatal stroke, MI and CV death, happened in 133 (2.2%) participants of intervention group and 177 (2.4%) in the control group. However, the improvement of composite CV events reduced 55% (adjusted HR = 0.45, 95% CI: [0.32,0.63]), and decreased by 55% (HR = 0.45, 95% CI: [0.37,0.63]) for all CV events. Conclusions: The effect of advised only lifestyle intervention used in our study is minor for CV prevention. However, the effect of improvement of lifestyle on CV prevention is indisputable even in hypertensives who receive a-hypertension drug treatment. (C) 2016 Elsevier Ireland Ltd. All rights reserved.