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Background: Guidelines exist streamlining the drug management of hypertension. We compared conformity of anti-hypertensive medication prescriptions to internationally acceptable guidelines at two tertiary hospitals in Nigeria.Methods: Antiypertensive prescriptions in consecutive patients with hypertension attending medical outpatient clinics at the Jos University Teaching Hospital (JUTH), Jos and the Federal Medical Centre (FMC), Makurdi were audited. Also evaluated among these patients were medication adherence and blood pressure control.Results: Appropriate prescriptions were present in 80.6% of the patients [89 (90.8%) JUTH patients and 86 (72.3%) FMC patients respectively; p = 0.0005]. The median number of drugs was two. Diuretics were the commonest drugs used (82.4% JUTH patients and 74.8% FMC patients; p = 0.18). Angiotensin converting enzyme inhibitors (ACEIs) were the second most commonly used medication (60.2% of JUTH and 52.9% of FMC patients respectively p = 0.28). The calcium channel blockers were used by 55.1% of JUTH 45.4% of FMC patients respectively (p = 0.15). Good medication adherence was present in 83 (84.7%) of JUTH and 78 (65.5%) of FMC patients; p = 0.001. BP control in the JUTH and FMC cohorts was 42.9% and 32.8% respectively; p = 0.12. On the whole, BP control was better among patients with good adherence compared to those without (41.6% vs. 25% respectively; p = 0.02).Conclusion: Anti-hypertensive prescriptions in this study conform to internationally acceptable guidelines. Diuretics and ACEIs are the most commonly used drugs. Renoprotection is however suboptimal in patients with DM. Keywords: Audit; Antihypertensive; Compelling Indications; Medications