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Hypertension is a major public health concern globally and is associated with high morbidity and mortality in sub-Saharan Africa. Although antihypertensive therapy is effective in lowering blood pressure, a large proportion of patients do not have optimal blood pressure control. To describe the prescribing pattern and utilization of antihypertensive drugs and assess blood pressure control in a rural reference tertiary hospital in Nigeria. We conducted a cross-sectional study of 212 adult patients with hypertension attending the cardiology clinic of the Federal Medical Centre, Ido-Ekiti, Nigeria, between February 2012 and July 2012. Anthropometric, clinical and therapeutic data were collected using a pre-tested pro forma. Data analysis was done using SPSS 16.0 software (IBM, Chicago, Il, US). P value< 0.05 (two-sided test) was considered to be statistically significant. We study 212 adults with hypertension, 48.1% of whom were male and the male-to-female ratio was 0.9. The mean age (±SD) of the patients was 61.5±15.1 years. Thirty two (15.1%), 95 (44.8%), 67 (31.6%) and 18 (8.5%) patients were on mono-, dual-, triple-and quadruple therapy respectively. Diuretics (84.9%) and calcium channel blockers (56.6%) were the most frequently used antihypertensive drugs. Blood pressure was controlled in only 45.3% of patients. Dual-and triple-therapy produced more patients with controlled blood pressure (dual-therapy, p= 0.30; triple-therapy, p= 0.11). Our study showed that diuretics were the most frequently prescribed class of antihypertensive drugs in our rural tertiary hospital as in many studies from …