OBJECTIVES: To assess the cost-effectiveness of antihypertensive treatment with nebivolol, atenolol or ACE inhibitor monotherapy in 60-year and 70-year-old patients with moderate hypertension in Germany. METHODS: Using a decision-analytic Markov model, we determined incremental cost-effectiveness ratios (ICER) of treatment with nebivolol, atenolol and ACE inhibitor monotherapy from third party payers' perspective over a 5-year time horizon. Effects on diastolic blood pressure were obtained from a pooled analysis of published randomized clinical trials using response and compliance data. The 5-year absolute risk for an initial coronary, cerebrovascular event or cardiovascular death was computed using the gender specific algorithm based on Framingham Heart Study data. Costs were derived from published tariff lists. Direct medical costs per patient included cost of drug treatment over the 5-year period and cost of acute care for coronary and cerebrovascular events. RESULTS: The comparison of nebivolol vs. ACE inhibitors showed that 3.5 (60-year-old men) and 3.4 (70-year-old men) life years more per 100 patients could be gained with nebivolol. With higher incremental costs, ICER for nebivolol versus ACE inhibitors were €2,025 (60-year-old men) and €1,824 (70-year-old men). In comparison to atenolol, 6.3 (60-year-old men) and 5.7 (70-year-old men) life years more per 100 patients could be gained. ICER for nebivolol versus atenolol were € 4,672 (60-year-old men) and € 4,704 (70-year-old men) per life-year gained. For women, the number of incremental life years gained was lower. ICER for nebivolol versus ACE inhibitors were €2,347 (60-year-old women) and €1,904 (70-year-old women) and for nebivolol versus atenolol €11,648 (60-year-old women) and €9,060 (70-year-old women) per life-year gained. CONCLUSION: Based on our decision analysis, the use of nebivolol was more effective than antihypertensive therapy with ACE inhibitors and atenolol. Antihypertensive treatment with nebivolol is a cost-effective treatment option from third party payer‘s perspective in Germany in the selected patient groups.