<p>Long-term blood pressure control is critical for stroke prevention in patients with hypertension. However, whether lifestyle behaviours can beneficially influence long-term blood pressure variability remains uncertain. This prospective cohort study was drawn from the China Stroke Primary Prevention Trial, which was a multi-community, randomized, double-blind, controlled trial conducted in China, involving 20,638 patients with hypertension. Eight stroke-related health behaviours were used to construct the lifestyle profile, including non-smoking, non-alcohol consumption, normal body shape, moderate or higher physical activity, high sleep quality, good stress status, a healthy diet, and regular folic acid supplementation. A composite score was calculated by summing the eight healthy factors, and based on stroke incidence, scores were grouped into Unfavourable (0–3), Intermediate (4–5), and Favourable (6–8). During the 4.5-year follow-up period, there were 634 incidents of stroke and 620 cases of all-cause mortality. The hazard ratios for stroke were 0.70 (95% CI: 0.54–0.92; <i>P</i> = 0.010) in the Favorable group, compared with the Unfavorable group. Similarly, the hazard ratios for all-cause mortality were 0.72 (95% CI: 0.56–0.93; <i>P</i> = 0.012) in the Favorable group. The mean treatment systolic blood pressure (SBP), diastolic blood pressure (DBP), 1-year blood pressure time in target range (TTR), SBP-TTR, and DBP-TTR, significantly mediated the association with stroke risk, accounting for 31.1%, 15.9%, 7.1%, 8.3%, and 7.2% of the total effect, respectively. For all-cause mortality, the treatment SBP also significantly mediated 11.4% of the overall association. This study demonstrated that among hypertensive patients receiving regular antihypertensive treatment, healthy lifestyle profiles were associated with lower risks of stroke and all-cause mortality, partially mediated by improvements in long-term blood pressure and greater time in target range.</p><p></p>