OBJECTIVES: To compare the incremental cost-effectiveness ratio (ICER) and incremental cost‑utility ratio (ICUR) of the angiotensin II receptor antagonist Azilsatan vs current treatments of the same drug class as valsartan, telmisartan, losartan and irbesartan.  METHODS: Cost-effectiveness and cost-utility analysis were conducted using a Markov model with a 35-year temporal horizon for patients over the age of 45 and diagnosed with systemic arterial hypertension to calculate the ICERs of each treatment. The model adopts the Mexican public health institutions’ perspective. Four health states were incorporated: alive and healthy, hypertensive with non-fatal acute myocardial infarction (AMI), hypertensive with non-fatal stroke and death. Transition probabilities were calculated based on the national risk of having a stroke or AMI and the probability of having a vascular complication depending on blood pressure levels (in mmHg). Costs and effectiveness data were taken from health institutions, producer pharmaceutical companies or extracted from published literature. Outcome measures included ICER and ICUR. Cost-effectiveness was determined according to the 1GDP/capita threshold established by the National Health Council in Mexico.  RESULTS: Azilsartan was found to be dominant when compared with telmisartan, valsartan and irbesartan. Azilsartan was also more effective when compared with losartan (10.76 vs. 10.47 life years gained) although more costly (USD$ 6,118.92 vs. USD$ 5,192.71). The ICER was USD$ 3,202.84 per life year gained.  According to the cost-utility analysis, the ICUR per quality‑adjusted life year gained was USD$ 3,458.09. CONCLUSIONS:  The ICER and ICUR are well below 1GDP (USD$ 9,350.07) per capita versus losartan. Both azilsartan and losartan were found to be dominant in comparison with the other included treatments. Azilsartan is therefore a very cost-effective intervention for the Mexican population over 45 with systemic arterial hypertension.