OBJECTIVES: To assess the cost per quality-adjusted-life-year (QALY) of Atorvastatin 10 mg (ATV) + Amlodipine 5/10 mg (AML) compared with Atenolol 10 mg (ATE) + ATV, in hypertensive patients with no history of coronary heart disease (CHD) with normal to mildly elevated cholesterol and with at least 3 additional cardiovascular-risk-factors (ASCOT-LLA patients). ASCOT-BPLA study compared 2 different antihypertensive strategies (ATE+/-Bendroflumethiazide+/-Doxazosin) and AML (+/-Perindopril+/-Doxazosin) to reduce cardiovascular events in 19,257 hypertensive patients. AML demonstrated less all cause mortality than ATE (p=0.025). A sub-study (ASCOT-LLA) comparing ATV to Placebo (PCB) in patients with =250 mg/dL was carried out. The ASCOT-LLA was early interrupted because of a significant reduction in the primary endpoint in favour of Atorvastatin. A factorial analysis of ASCOT-LLA (ATV+AML; PBO+AML; ATV+ATE; PBO-ATE) demonstrated a 53% relative risk reduction of ATV+AML versus PBO+ AML (p<0.0001); and of 39% for ATV+AML versus ATV+ATE (p=0.016). METHODS: Two hypothetical cohorts of ASCOT-LLA like patients were simulated for a 25 years time horizon under the perspective of the National Health System, by a Markov model. Spanish costs (€2005) of ATV, AML, ATE, Peridonpril and Bendroflumethiazide were taken into account. Effects were based on results of the ASCOT 2x2 analysis: ATV+AML versus ATV+ATE. Results are expressed as incremental cost-effectiveness ratio (ICER) per QALY. Costs and effectiveness outcomes were discounted at a rate of 3% and 5% per year, respectively. RESULTS: The basecase analysis demonstrates that ATV+AML strategy is a more effective alternative with an acceptable increase in costs: ICER of ATV+AML was 17.334€ per QALY. CONCLUSION: Atorvastatin + Amlodipine is a cost-effective strategy when compared with Atorvastatin + Atenolol for the treatment of hypertensive patients with no prior history of cardiovascular disease, normal to mildly elevated cholesterol levels and with at least 3 additional cardiovascular-risk-factors, being under the threshold of 30.000€ per QALY usually accepted in our environment.