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Chloride (Cl⁻) is the major extracellular anion in the body, accompanying sodium (Na⁺), and is primarily derived from dietary sources. Data suggest that increased dietary Cl⁻ intake increases blood pressure, yet paradoxically, higher serum Cl⁻ appears associated with lower mortality and cardiovascular risk. This implies that serum Cl⁻ also reflects risk pathways independent of blood pressure, serum Na⁺, and bicarbonate (HCO₃⁻). We analyzed 12 968 hypertensive individuals followed up for 35 years, using Cox proportional hazards model to test whether baseline serum Cl⁻ was an independent predictor of mortality. To distinguish the effect of Cl⁻ from Na⁺ and HCO₃⁻, we adjusted for these electrolytes and also performed the analysis stratified by Na⁺/HCO₃⁻ and Cl⁻ levels. Generalized estimating equation was used to determine the effect of baseline Cl⁻ on follow-up blood pressure. The total time at risk was …