OBJECTIVES: To analyse the incremental cost-effectiveness ratio (ICER) between combination angiotensin II receptor antagonists + thiazides. Specifically, comparing azilsartan + clortalidona vs. current available treatments: valsartan + hydrochlorothiazide, telmisartan + hydrochlorothiazide, losartan + hydrochlorothiazide and irbesartan + hydrochlorothiazide. METHODS: Cost-effectiveness analysis was conducted using a Markov model with a 35-year temporal horizon for patients over the age of 45 and diagnosed with systemic arterial hypertension. The model adopts the Mexican public health institutions’ perspective. Four health states were incorporated: healthy, hypertensive with non-fatal acute myocardial infarction (AMI), hypertensive with non-fatal stroke and death. Transition probabilities were calculated based on the national risk of stroke or AMI, and the probability of having a vascular complication depending on blood pressure levels (in mmHg). Costs and effectiveness data were taken from public health institutions, producer pharmaceutical companies or extracted from published literature. Final outcome was measured in ICER per life year gained (LYG). Cost-effectiveness was determined according to the 1GDP/capita threshold established by the National Health Council in Mexico. RESULTS: Azilsartan + chlortalidone was found to be dominant compared to all other treatments with a total cost of USD$2,873.57 over 35 years, and an effectiveness of 12.23 LYG. The next most cost-effective comparator, losartan + hydrochlorothiazide, presented an ICER of USD$349.21; however due to a difference in efficacy of -0.68 LYG, azilsartan + chlortalidone remained dominant even with a 10% increase in price.   CONCLUSIONS: Azilsartan + chlortalidone was found to be dominant in comparison with all other included treatments. Azilsartan is therefore a very cost-effective intervention for the Mexican population over 45 with systemic arterial hypertension.