OBJECTIVES: Hypertension is a major risk factor for cardiovascular disease and a leading cause of morbidity and mortality. The present study evaluates irbesartan in relation to losartan and valsartan in the treatment of hypertension in Greece. METHODS: A Markov model was constructed with eight health states, including: hypertension, myocardial infarction, post-MI, angina, stroke, post-stroke, heart failure and death. It has an annual cycle and estimates mean quality-adjusted survival and treatment cost, which reflects hypertension treatment and the management of cardiovascular events. Risk functions were used to conduct extrapolations. Data on treatment effectiveness, quality-of-life and epidemiology were obtained from published clinical trials and studies. The database of the main insurance fund (IKA) was analysed to estimate the cost of events. The analysis was done from a payer perspective, all outcomes were discounted at 3% and prices correspond to 2008. RESULTS: The estimated patient cost per annum for each health state was: stable angina: €2,252; unstable angina: €2572; myocardial infarction: €2473; post-MI: €1677; stroke: €12,233; post-stroke: €1,240; heart failure: €2,655; angiogram: €1,544;  angioplasty: €6,511€; bypass surgery; €11,514. For the baseline group (age: 57 years, systolic-blood-pressure: 147, cholesterol: 6.00mmol/L, BMI: 29kg/m2) with mild/moderate disease, the total cost was €15,146 with irbesartan, €15,486 with losartan and €15,613 valsartan; QALYs were 12.67, 12.63 and 12.64, respectively. For the group with severe disease, the total cost with irbesartan) was €15,798 (150mg) and €18,697 (300mg), whilst with Losartan was €16,295 (50mg) and €22,496 (100mg); QALYs were 12.47 and 12.37 for irbesartan and losartan respectively. Thus, irbesartan was less costly and more effective and dominated the other two treatments. Similar results were obtained in relation to various other patient groups and several sensitivity analyses. CONCLUSIONS: For different patient populations, irbesartan represents good value for money in the Greek NHS setting, compared to selected commonly used alternatives.