The North Karelia Hypertension Program was initiated in 1972 as part of the North Karelia Project. This article examines the costs and effects of the first 5 years of the project. There were 288 fewer than expected fatal strokes and myocardial infarctions during the period; 134 of these are attributable to the hypertension program. The costs of the hypertension program totalled $5.16 million. Drugs consumed 86% of this cost. Using the zero discount rate as an outside boundary, the program is expected to increase old age pension costs by $2.5 million for the 5 years but will decrease earnings losses by $7 million for the same period. With earnings excluded, the cost per quality-adjusted life-year gained is $3,612 at zero discount and $5,830 at 10% discount. Hypertension care is more cost-effective than many of the treatments applied after the appearance of coronary heart disease symptoms but would be much more cost-effective if hypertension could be treated as effectively without medications or if the costs of medications could be reduced.