INTRODUCTION: Hypertension, a risk factor for cardiovascular disease (CVD), is frequently associated with other CVD risk factors. Despite recent improvement in blood pressure (BP) control in Europe, a substantial proportion of patients fail to achieve BP targets. METHODS: This retrospective cohort study used longitudinal patient databases (LPDs) in France and Italy to examine CVD risk profiles, treatment patterns, and BP goal attainment in hypertensive patients treated in real-world clinical practice between 2007 and 2008. Overall, 147,964 and 140,189 eligible patients from LPDs in France and Italy, respectively, were prescribed an antihypertensive medication in 2007. RESULTS: Among patients with hypertension with other risk factors (France 88 %, Italy 83 %), the most prevalent risk factors were being elderly (France 66.9 %, Italy 70. 9 %), followed by hypertension combined with dyslipidemia (France 36.7 %, Italy 23.9 %) and isolated systolic hypertension (France 32.5 %, Italy 24.2 %). The odds ratios for target BP attainment were significantly (p < 0.001) higher in patients with hypertension without other risk factors vs patients with hypertension with other risk factors (1.41 [95 % confidence interval 1.35, 1.48] in France; 1.38 [1.31, 1.46] in Italy). The odds of BP control were significantly lower for patients with vs patients without an associated CVD risk factor (range 0.54 to 1.10 France; 0.59 to 1.17 Italy). DISCUSSION: This study demonstrates that the majority of treated hypertensive patients in France and Italy have at least one additional CVD risk factor. Despite treatment with antihypertensive medications, blood pressure attainment was substantially less optimal in patients with an associated CVD risk factor compared to patients without an associated CVD risk factor.