The cost of treating patients with hypertension is estimated to be a staggering $US2 billion/year in the US. Potentially, this figure could soar even higher, according to information from the National Center for Health Statistics that suggests about 50 million Americans have high BP, but that this is only adequately controlled in 12 million patients. Clinical trials are required to demonstrate efficacy and tolerability before any new drug can gain regulatory approval. However, this information may not be sufficient to gain formulary approval. Most managed care organisations now also want to see outcomes data as part of their decision making process. In this respect, ‘real-life’ data, derived from actual practice settings are needed. Results from the first prospective, head-to-head study of treatment costs in patients with hypertension were reported at the 10th Annual Meeting of the National Managed Health Care Congress [Atlanta, US; April 1998]. This naturalistic outcomes study compared calcium antagonist therapy with either mibefradil [‘Posicor’] or the current gold-standard agent, amlodipine [‘Norvasc’].