OBJECTIVES: Olmesartan medoxomil is one of the latest angiotensin II receptor blockers (ARB) approved for use in the Russian Federation. The objective was to assess cost-effectiveness of olmesartan compared with losartan and valsartan in adult patients with mild and moderate essential arterial hypertension. METHODS: The study was performed by modeling and cost-effectiveness analyses. We have also assessed cost-effectiveness ratio (СЕR) growth rate, which represents the relative rate of change in value for the analyzed periods. Analyzed costs included brand drugs only. Efficacy data were obtained from a head-to-head clinical trial, in which office blood pressure rate, number of patients with mild and moderate arterial hypertension achieving target blood pressure in weeks 4, 8, and 12 were taken into account. Patients with diabetes mellitus and chronic renal failure were analyzed separately. The time horizon of the analysis was 12 weeks. Pairwise comparison of costs, CER, CEAincr and СЕR growth rate were performed separately for olmesartan vs. losartan, and olmesartan vs. valsartan. RESULTS: Treatment with olmesartan provides more clinical effect for less costs and demonstrates better cost-effectiveness ratio than losartan  or valsartan in terms of target BP after 12 weeks. In both pairs, CER growth rate was minimal in case of olmesartan; this reflects the dynamics of this value during treatment. Similar results were obtained for comparable ARBs in patients with diabetes mellitus and renal failure. CONCLUSIONS: Cost-effectiveness analysis shows that treatment of mild arterial hypertension with olmesartan is more appropriate from the pharmacoeconomic point of view than losartan and valsartan, both in general group and in patients with diabetes mellitus and renal failure.