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The paper reviews the input of arterial hypertension (AH) and its complications in 1983-2005 cardiovascular mortality among Astrakhan City citizens. Based on the 22-year follow-up data, the authors analysed the mortality from myocardial infarction (MI) and stroke (S), in regard to anamnestic evidence of AH presence/absence. It was demonstrated that AH was a critical, often fatal, factor in fatal MI and S development. Over 1983-2005, Astrakhan City experienced a significant increase in cardiovascular mortality, similar to that in other Russian regions. Anamnestic evidence of AH was present in over 80% of the fatal cases.