Background: We assessed the cost-effectiveness of pharmacological treatments for hypertension to prevent coronary heart disease and stroke in Catalonia (Spain)., Methods: Cost-effectiveness was measured as the cost in Spanish Ptas per life year gained (LYG) in 1998 in individuals aged 40 to 69 years with moderate/severe hypertension (>= 105 mmHg) and mild hypertension (95-104 mmHg). We evaluated hydrochlorothiazide (diuretic), propranolol (-blocker), nifedipine (calcium antagonist), captopril (angiotensin-converting-enzyme inhibitor) and prazosin (*-adrenergic blocker)., Results: Cost-effectiveness ranged from 706,100 to 446,780 ptas. per LYG in men and from 635,100 to 810,270 ptas. per LYG in women with moderate/severe hypertension and from 108,770 to 682,460 ptas. per LYG in men and from 101,000 to 12,699,000 ptas. per LYG in women with mild hypertension. Incremental cost-effectiveness analysis showed that hydrochlorothiazide and propranolol were the most cost-effective treatments in individuals with moderate/severe hypertension while hydrochlorothiazide and nifedipine were most cost-effective in those with mild hypertension., Conclusion: In this study, greatest-to-lowest cost-effectiveness of assessed treatments was as follows: hydrochlorohiazide, propranolol, nifedipine, prazosin and captopril in moderate/severe hypertension and hydrochlorothiazide, nifedipine, propranolol, prazosin and captopril in mild hypertension.