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The prescribing pattern and drug use in the management of essential hypertension in a general hospital and its conformity to the JNC VII and WHO/ISH management guidelines was investigated. 1673 prescriptions from a total of 205 case files of hypertensive patients (> 18 years) attending the medical out-patients department of a general hospital between January and December 2009, were retrospectively surveyed. Results showed that the most prescribed antihypertensive drug class was the Fixed Dose Combinations (FDC) (26.83%) followed by Calcium Channel Blockers (20.83%), ACE Inhibitors, (11.15%) and Diuretics (7.88%). Individually, the fixed dose combination diuretic; Hydrochlorothiazide + amiloride (Moduretic) (26.04%) was the most prescribed drug followed by Nifedipine (11.81%), Lisinopril (11.15%), Amlodipine (8.65%), and Bendroflumethiazide (5.02%). Combination therapy (73.38%) was used more commonly than monotherapy (22.50%). Among the combination therapies, 2- drug therapy (28.97%) was more preferred than the 3-drug (19.90%).Fixed Drug Combination (FDC) (35.62%) and Diuretic + 2 drugs (11.59%) were the most prescribed combinations. The study also shows that of the 1673 numbers of encounters, there were a total of 5973 drugs and 102 non-drug interventions. The average number of drug per encounter was 3.6. 31.2% of the drugs were prescribed by generic name and 82.5% were from the Essential Drug List (EDL). The percentage of encounter with antibiotics and injections were 7.36% and 0.7% respectively. The pattern of antihypertensive utilization complied partially to the JNC 7 guideline and WHO/ISH 1999 guidelines but did not conform to the Essential Drug List Act of Nigeria.