Hypertension is a cardiovascular disease with high morbidity and mortality. Effective blood pressure control can be achieved in patients with lifestyle modifications and by the use of antihypertensive agents. The objective of this study was to determine the prescribing pattern of antihypertensive medications in a tertiary health institution in South-Eastern Nigeria and also to determine the prescribers' compliance to recognised treatment guidelines. This was a retrospective cross sectional study and a total of 848 prescriptions generated from 202 hypertensive case files were used. Data extracted from the case files of hypertensive patients who attended the hospital from January to December, 2010 were coded and analysed using Statistical Package for Social Sciences (SPSS). The mean age of the patients consisting of mainly females (n=119, 59%) and then, males (n=83, 41%) was 59 years. Stage 2 hypertension was the most common class seen among the patients followed by stage 1 and then, the prehypertension with antihypertensive agents prescribed at all the stages. Co-morbid conditions increased with increase in blood pressure with type 2 diabetes being the most common, followed by congestive heart failure (CHF). The study also showed that the two most commonly prescribed agents either as monotherapy or as combination therapy were diuretics (D) and calcium channel blockers (CCBs) followed by angiotensin converting enzyme inhibitors (ACEIs) with angiotensin receptor blockers (ARBs) being the least prescribed. This study showed that there were reductions in the mean systolic and diastolic blood pressures with a decrease in mean arterial pressure (MAP) from 118 to 104 mmHg after initiation of therapy. This study shows a good adherence to current evidence based treatment guidelines and hypertension treatment guidelines.