OBJECTIVES: To establish the relationship between cardiovascular risk (CVR) and health-related quality of life (HRQoL), as well as the presence or absence of comorbidities, in a Spanish hypertensive population. METHODS: Epidemiological, cross-sectional, multicenter study conducted in adult patients with essential hypertension of ≥1 year of evolution. Patients were stratified in 5 categories according to the CVR within 10 years (ESH/ESC, 2007): average, low added, moderate added, high added and very high added CVR. HRQoL was measured by MINICHAL questionnaire. It comprises 2 domains (mental status and somatic manifestations) referred to the past week. Overall scores range from 0 to 48, with higher scores representing worse HRQoL. Presence of kidney and cardiovascular disease was evaluated. RESULTS: A total of 6,654 patients (55.2% male) were assessed; median age (Q1, Q3) 63.0 (55.0, 72.0) years and time since hypertension diagnosis 6.5 (2.9, 10.7) years. Average CVR was presented in 3.5%, low added in 13.6%, moderate added in 12.8%, high added in 39.0% and very high added in 31.0% of patients. Overall MINICHAL scores ranged from 4.0 (2.0, 8.0) in patients with average CVR to 11.0 (5.0, 18.0) in patients with very high added CVR (p<0.0001). Mental status and somatic manifestations domains scores ranged from 4.0 (1.0, 6.0) for average CVR to 8.0 (4.0, 13.0) for very high added CVR, and from 0.0 (0.0, 2.0) for average CVR to 3.0 (1.0, 6.0) for very high added CVR, respectively (p<0.0001, in both cases). Overall MINICHAL scores related to comorbidities (presence vs. absence) were: kidney disease 13.0 (7.0, 20.0) vs. 7.0 (3.0, 12.0) and cardiovascular disease 10.0 (5.0, 17.0) vs. 6.0 (3.0, 12.0), [p<0.0001, in both cases]. CONCLUSIONS: Hypertensive patients with increased CVR show significant worse HRQoL, in both mental status and somatic manifestations domains. The presence of comorbidities is associated with a worse HRQoL.