OBJECTIVES: The management of arterial hypertension in France starts with an evaluation of the patient’s cardiovascular risk (function of age, sex, cholesterol level, systolic blood pressure [SBP]) and if necessary, the prescription of a recommended class among angiotensin converting enzyme (ACE)-inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers (CCB) and thiazide diuretics. The objective of this study was to assess, for different patient’s profiles, the cost-effectiveness of the recommended antihypertensive classes in France. METHODS: A cohort of newly treated patients entered a Markov model, using 1-month cycles in the first year, 1-year cycles until 10 years then lifetime extrapolation of costs and benefits. The cohort was characterized by its cardiovascular risk, evaluated via the France-specific Framingham equation. The risk reductions per class versus placebo were taken from the most recent meta-analyses. The probability to switch from monotherapy to bitherapy and tritherapy was depending on the achieved SBP (target 140mmHg) and the class-specific persistence. National health care databases provided persistence and costs data. Discount rate was 4% (costs and life-years). RESULTS: In low-risk patients (65-year-old female, SBP 150mmHg), incremental cost-effectiveness vs. placebo ranged from 101€/life-year gained (ACE-inhibitors followed by ACE-inhibitors/thiazides) to 7,722€/life-year gained (beta-blockers followed by beta-blockers/CCB). Savings and extra benefits vs. placebo were obtained in high-risk patients (74-year-old diabetic male, smokers, SBP 180mmHg): up to 0.57 life-years gained with total costs reduced from 17,630€ to 15,403€ (ACE-inhibitors followed by ACE-inhibitors/CCB, least expensive sequence) and 15,953€ (beta-blockers followed by beta-blockers/ARBs, most expensive sequence). The classes ranking was influenced by the persistence and diabetes incidence. The differences were significant vs. placebo but not between the classes, as per probabilistic sensitivity analysis. CONCLUSIONS: This lifetime model suggests that all recommended anti-hypertensive drugs in France are very cost-effective versus placebo, and, in higher-risk patients, are even cost-saving with savings comparable among the classes.