The main objective of the study is to assess the prescribing pattern of anti- hypertensive in a tertiary level referral hospital in south Malabar region of Kerala. Hypertension is a growing worldwide problem associated with an increased risk of cardiovascular morbidity and mortality. The rates of prevalence of hypertension are higher in some populations than others. Although ethnic and genetic factors have been implied in the past to explain this, the environmental influence and psychosocial factors may play a more important role. Examining the non-genetic influences in future hypertension research may be necessary in order to clearly define the local blood pressure demographics and the global hypertensive disease burden. In our study of drug prescribing patterns for hypertension in Al Shifa hospital, it was found that most patients were being treated with two or more drugs. Although b-blockers were the most frequently prescribed antihypertensive agents, CCBs and diuretics were prescribed sparingly. Among different classes of antihypertensive drugs specific drugs like atenolol, amlodipine, and furosemide occupied large proportion of the prescription. Newer and more expensive drugs, e.g. benazepril, ramipril, and losartan, were advised in a significant number of prescriptions, which added to the cost of drug treatment. Cost is being an important consideration for therapy of a chronic disease like hypertension, often requiring lifelong medication.