OBJECTIVES: The long-term benefits on life expectancy of more effective antihypertensive strategies to lower blood pressure are not well described, particularly for certain groups with different cardiovascular (CV) risk factor profiles. We projected the life expectancy benefits of anti-hypertensive treatment strategies using a unique primary/secondary prevention Markov Model derived from a large epidemiologic database. METHODS: Longitudinal data from 57,279 middle-aged and older male and female health professionals were pooled to develop a primary and secondary CV event Markov model estimating the long-term benefits of antihypertensive treatment based on both systolic and diastolic blood pressure reduction. Seven patient states were defined: no CV event history, stroke, myocardial infarction, revascularization, non-CV death, CV death, and history of CV event. Risk functions were developed from gender-specific multivariate Cox proportional hazards models for primary events, and age-adjusted models for secondary events. The area between survival curves of different interventions was calculated to estimate the incremental gains in life expectancy for the superior antihypertensive treatment intervention. RESULTS: We assumed a pre-treatment blood pressure of 160 mmHg systolic / 95 mmHg diastolic. We further assumed that Strategy A yields a lowering of 20/13 mmHg and Strategy B yields a reduction of 13/8 mmHg. Post treatment blood pressures at the start of the simulation were thus 140/82 mmHg for Strategy A and 147/87 mmHg for Strategy B. Assuming an age of 35 years at baseline and cycling the model for 65 years, a life expectancy gain of 0.7 years is achieved for Strategy A versus Strategy B. In a diabetic population, there was a life expectancy gain of 0.79 years for Strategy A versus Strategy B. CONCLUSIONS: Substantial gains in life expectancy due to reduction in both primary and secondary CV events can be achieved by superior strategies of blood pressure lowering.