During the development of hypertension a progressive increase in left ventricular mass (LVM) occurs. This hypertrophy is a predictor of the incidence of cardiovascular disease and mortality. The great majority of anti-hypertensive drugs lead to a reduction of LVM, thus improving the prognosis. It is not known, however, which of these drugs is the most cost-effective in terms of reduction of LVM. OBJECTIVE: To investigate the cost of reducing LVM by 1 gram with various agents during the treatment of hypertension. METHODS: Out of 28 trials published between 1984 and 1995, only 17 were included (528 patients, 21 drugs from main anti-hypertensive classes including ACE inhibitors, or drug combinations) because they were of 12 months duration. The cost of drugs used (at Polish prices) for the treatment period was divided by the delta change in LVM in grams during that period. RESULTS: The most cost-effective drugs in terms of LVM reduction (USD/gram of muscle) were: atenolol 0,11; prazosin 0,34; hydralazine 0,44. Combinations of anti-hypertensives were highly cost-effective: rezerpine + hydrochlorothiazide 0,11; atenolol + indapamide 0,92. CONCLUSION: These results may serve as a guide in decision-making for the choice of treatment and reimbursement.