OBJECTIVES: This study was performed to evaluate and provide a new positive list of  antihypertensive drugs for reimbursement in the Korean national health insurance. METHODS: First, among total 1,226 items, 360 combination items were excluded from this evaluation and 25 essential drug items (ban-on-delisting drugs, orphan drugs, emergency drugs, and drugs without any alternatives) were to remain on reimbursement list without any evaluation. Next, clinical usefulness was evaluated by criteria from medical textbooks, guidelines, and WHO lists, and 1 item was to be delisted due to lack of clinical usefulness. In the third step, daily cost was calculated. Drugs which belong to bottom 25% in daily cost were defined as “relatively low-price drugs,” which could remain on the list without subsequent evaluation. Other drugs were to be evaluated by cost-effectiveness. Clinical effectiveness was evaluated based on proxy outcomes (blood pressure) and final outcomes (mortality, morbidity) by reviewing clinical literatures and 6 assessment reports from overseas health technology institutions as well as opinions of clinical experts. RESULTS: There was no clear evidence depicting differences in clinical effectiveness. Therefore, the prices of hypertension drugs would have to be reduced to the lowest level of all hypertension drugs if a cost-minimization principle is applied. However, the lowest levels within each class were suggested instead in recognition of differences in adverse events and effects on co-morbidity among the classes. CONCLUSIONS: It was not proven that a particular class or ingredient among hypertensive drugs was superior to others. However, the policy based on this result has to be carefully implemented. It is important that practicability, fairness, and equity of the result as well as scientific accuracy have to be balanced since this type of study is commonly associated with interests of stakeholders.