The recent Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure reported that barely half of patients treated for hypertension achieve control of blood pressure (BP). OBJECTIVE: To estimate the clinical and economic benefits of disease management programs aimed at achieving BP goals in treated hypertensives. METHODS: We developed an economic model of cardiovascular disease (CVD) and its relationship to diastolic blood pressure (DBP) and antihypertensive treatment. This model forecasts CVD incidence and direct medical-care costs for specified populations, such as the membership of a managed-care plan, and simulates the effect of programs to improve BP control. CVD risk was estimated using new equations developed for this purpose from the Framingham Heart Study. Other principal data sources included major national health surveys and healthcare costs databases. RESULTS: We estimate that in an average health care plan, 22% of members aged 40-79 years receive antihypertensive therapy, and at routine follow-up 15% of the latter will be found to have uncontrolled DBP (³ 90 mmHg). For every 1000 such patients, further intervention to achieve BP control is expected to prevent 39 CVD events and save $515,000 in CVD treatment costs over five years. If intervention is limited to those with prior history of CVD it will prevent 54 events and save $834,000 per 1000 patients. Further limitation of intervention to those ³60 years of age increases these benefits to 67 events and $1,014,000 per 1000. CONCLUSION: Disease management programs that target treated but uncontrolled hypertensives can be expected to yield substantial economic benefits in addition to preventing cardiovascular morbidity and mortality.