Objective: This study was aimed at verifying whether combined information on l eft ventricular perfusion and function by electrocardiogram-gated single-photo n emission computed tomography(SPECT) retains its known prognostic value in pati ents with systemic hypertension. Methods: A total of 415 hypertensive patients u nderwent rest and stress(exercise in 278 and dipyridamole in 137) gated 99mTc-s estamibi SPECT and prospective follow-up for the composite endpoint of death an d acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome was evaluat ed by Cox regression analysis. Model validation was performed using bootstrap me thods adjusted by the degree of optimism in estimates. Survival analysis was per formed using the product-limit Kaplan-Meier method. Results: During a median f ollow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurr ed. After adjusting for the most significant covariates, age[hazard ratio(HR) 1. 62, 95%confidence interval(CI) 1.02-2.57], diabetes(HR 7.51, 95%CI 1.61-35.2 ), summed stress score(HR 2.06, 95%CI 1.07-4), and peak end-systolic volume(H R 3.62, 95%CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end -systolic volume. Conversely, in the case of moderate to severe perfusion abnor malities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was sign ificantly higher among patients who died of a cardiac cause compared with those with different outcomes. Conclusion: A combined assessment of left ventricular p erfusion and function by gated SPECT significantly improves risk strati fication in hypertensive patients. Objective: This study was aimed at verifying whether combined information on l eft ventricular perfusion and function by electrocardiogram-gated single-photo n emission computed tomography (SPECT) retains its known prognostic value in pati ents with systemic hypertension. Methods: A total of 415 hypertensive patients u nderwent rest and stress (exercise in 278 and dipyridamole in 137) gated 99mTc-s estamibi SPECT and prospective follow-up for the composite endpoint of death an d acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome were evaluat ed by Cox regression analysis. Model validation was performed using bootstrap me thods adjusted by the degree of optimism in estimates. Survival analysis was per formed using the product-limit Kaplan-Meier method. Results: During a median f ollow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurr ed. After adjusting for the most signi ficant covariates, age [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.02-2.57], diabetes (HR 7.51, 95% CI 1.61-35.2), summed stress score (HR 2.06, 95% CI 1.07 -4), and peak end-systolic volume (HR 3.62, 95% CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end-systolic volume. Conversely, in the case of moderate to severe perfusion abnor malities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was sign ificantly higher among patients who died of a cardiac cause with those with different outcomes. Conclusion: A combined assessment of left ventricular pfusion and function by gated SPECT significantly improving risk stratiging in hypertensive patients.