OBJECTIVES:  To systematically review the economic outcomes of olmesartan as monotherapy or in combination with other antihypertensive agents in the treatment of hypertension. METHODS:  A literature search was performed using PubMed and the Cochrane library until December 2015, with no limit on publication date, using predetermined key-words by a group of experts with relevant methodological and clinical expertise. Following the initial electronic literature search, the citations and abstracts of the identified studies were reviewed and assessed for inclusion by two independent researches based on pre-determined inclusion and exclusion criteria. The study selection process proceeded in two main stages. Background information of the study, participants’ characteristics and study outcomes were collected using data extraction forms developed specifically to address the review issues in hand. A quality assessment of the studies was conducted by two reviewers, using the Quality of Health Economic Studies (QHES) instrument. RESULTS: The literature search identified a total of 5 full articles that met the inclusion criteria. Two studies reported that the use of olmesartan compared to irbesartan, losartan and valsartan was associated with cost savings due to fewer cardiovascular disease cases, congestive heart disease cases, myocardial infarction cases and incidences of stroke. A cost-benefit analysis comparing olmesartan with candesartan, combined with thiazide and Calcium Channel Blockers (CCB) where needed, revealed that despite the higher acquisition cost of olmesartan compared to candesartan, its superior BP lowering effect generated lower overall cost per patient. Finally, cost-effectiveness studies revealed that olmesartan may be more cost-effective than other Angiotensin receptor blockers (ARBs) such as losartan, valsartan, and irbesartan. CONCLUSIONS: Olmesartan was also found cost-effective compared with other ARBs, though this area has yet relatively poor evidence and needs to further be explored.