Scholze et al. BMC Public Health 2010, 10:529 http://www.biomedcentral.com/1471-2458/10/529 Page 9 of 12 Table 3 Sensitivity analysis, total annual cost-of-illness (Euros, millions) of hypertension in the presence and absence of MetS; 2008 Germany Spain Baseline Presence Absence Type 2 diabetes; including only incident type 2 diabetes Presence Absence Proportion treated; assume 58% hypertensive subjects were treated in Spain Presence Absence Continuation rate; vary by 20% above/below the mean + 20% Presence + 20% Absence - 20% Presence - 20% Absence Costs; vary by 20% above/below the mean Drug costs + 20% Presence + 20% Absence - 20% Presence - 20% Absence CVD costs + 20% Presence + 20% Absence - 20% Presence - 20% Absence Type 2 diabetes costs + 20% Presence + 20% Absence - 20% Presence - 20% Absence 24,427 5,341 8,753 3,382 24,418 5,357 24,406 5,302 24,553 5,423 24,247 5,224 25,481 5,682 23,373 5,000 27,743 5,735 21,112 4,948 1,908 2,683 1,050 2,115 2,010 3,058 1,913 2,707 1,898 2,635 1,928 4,329 1,886 2,603 2,049 2,934 1,769 2,431 2,102 2,803 1,715 2,564 Italy 4,877 5,956 1,775 3,876 4,895 6,035 4,850 5,831 4,929 6,147 4,825 5,762 5,041 6,276 4,714 5,637 5,573 6,392 4,183 5,521 protective effect against initiation or progression of nephropathy.’ Evidence suggests that newer antihypertensive medica- tions are associated with a reduced risk of incident dia- betes [39] and that they are also associated with better adherence to therapy [38,56,57]. Although meta-analyses suggest antihypertensive drugs have a similar effect on reducing cardiovascular events [58], there is some evi- dence to suggest that newer antihypertensive medica- tions may lead to a greater reduction in the risk of first hypertension-related cardiovascular or diabetic event [57]. In addition, it has been recently demonstrated that obese hypertensive patients under drug-based weight loss therapy show significantly better weight reduction and improvement of insulin resistance when treated with newer antihypertensive medications compared to the older blood pressure lowering drugs (beta blocker, diuretics) [59]. Of the newer antihypertensive treatments ARBs have been found to be associated with the highest level of adherence [38,56,57] and the lowest association with incident diabetes [39]. Furthermore specific ARBs have also demonstrated favourable metabolic effects not present in other ARBs or ACE-inhibitors [60]. Following such guidelines which recommend the aggressive management of these high risk patients with a combination of lifestyle interventions to treat the MetS components present in the hypertensive individual and to prevent the onset of additional components is likely to lead to a significant reduction in costs of care. Newer antihypertensives lead to better control of blood pressure in part brought about by better adherence, thereby reducing the risk of cardiovascular disease. They also reduce the risk of new onset type 2 diabetes. Such outcomes are associated with significant associated costs. Therefore, in patients with hypertension and MetS, some of the drug costs of newer antihypertensive medications will be balanced by costs saved from redu- cing these negative outcomes. The magnitude of these