OBJECTIVES: Recently, “2014 evidence-based guideline for the management of high blood pressure in adults” was published by the Eighth Joint National Committee (JNC 8), in which the threshold of initiate pharmacologic treatment to lower blood pressure at systolic blood pressure (SBP) was increased from 140 to 150 mmHg. Considering the scarcity of economic evaluation of threshold for initial hypertension treatment, the aim of this study was to evaluate whether the new threshold of initial hypertension treatment is cost-effective compared to the former one from a third party payer perspective. METHODS: A state-transitional model was built using published evidence comparing the quality adjusted life years (QALYs) patients 60 years or older gained using different threshold of initial hypertension treatment. The QALYs and occurrence of CVD were used as primary and secondary outcome. The model used a life-time framework adopting a third-party payer’s perspective. Incremental cost-effectiveness ratio (ICER) between groups was calculated in U.S. dollars per QALY gained. Both one-way sensitivity analyses and probabilistic sensitivity analysis were conducted to explore the uncertainty of variables. RESULTS: The ICER for the base case of the new guideline versus the original one was 30,298 U.S. dollars per QALY gained. Other than age of patients, there is no variable could significantly influence results. There would be a 32% of more effective and less costly using new guideline threshold, and overall 83% chance of being cost-effective compared with the original one. CONCLUSIONS: The results indicated that it high likely that the new guideline of threshold for initial hypertension treatment is cost-effective than the original one, which means for patients older than 60 years diagnosed with hypertension, the initial anti-hypertension treatment could be given till the SBP comes to 150 mmHg.