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To assess longitudinal trends in cardiovascular mortality and population mean blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative Czech population sample from 1985 to 2007/2008.Source data on mortality rates were provided by the Czech Statistical Office and further processed by the Institute for Health Information and Statistics of the Czech Republic. Six independent cross-sectional population surveys were conducted in 1985, 1988, 1992, 1997/1998, 2000/2001, and 2007/2008 with randomly selected men and women aged 25–64 years and resident in six districts of the Czech Republic (Praha-východ, Benešov, Pardubice, Chrudim, Cheb, and Jindřichův Hradec). The total number of participants was 13 972.Since 1985, there has been a significant continuous, almost linear decline in standardized total, cardiovascular disease, ischemic heart disease, and stroke mortality (P < 0.001).There was a significant downward trend in the population mean SBP (from 133.6 ± 20.2 to 129.5 ± 18.5 mmHg; P < 0.001) and DBP (from 84.1 ± 11.3 to 82.5 ± 10.0 mmHg; P < 0.001) from 1985 to 2007/2008. This was associated with a significant decrease in the prevalence of hypertension only in women (from 42.5 to 37.2%; P < 0.001). Awareness of hypertension increased in both sexes (men, from 41.4 to 68.4%; women, from 58.9 to 71.4%; both P < 0.001) as did the number of individuals on antihypertensive medication (men, from 21.1 to 58.2%, women: from 38.9 to 58.9%; both P < 0.001). Control of hypertension improved significantly (from 3.9 to 24.6%) over the same period.The reduction in population blood pressure and improved hypertension control may have contributed substantially to the decrease in cardiovascular disease mortality in the Czech Republic.