OBJECTIVES:  We aimed to evaluate national and sub-national utilization pattern of antihypertensive medicines in Iranian population in past decade and evaluate whether there was any wealth-related inequality in these medicines` utilization among different provinces. Then, we assessed total and each class effectiveness of these medicines upon observational data. METHODS:  Either fixed effect or random effect linear panel data model was used to check wealth index effect on all and each class of antihypertensive medicines utilization, adjusting for other covariates including years of schooling, urbanization, mean age, and food type of provinces. The principal component analysis was applied to make summery measures for covariates using available national datasets. Then we used both Maximum likelihood and Bayesian multilevel modeling on both individual and provincial level covariates to evaluate antihypertensive medicines utilization effect. RESULTS:  The wealth category effect on all antihypertensive medicines utilization among Iranian provinces was positive and significant (0.845; 95% CI: 0.092, 1.598). Accordingly as subgroup analysis, in BBs and CCBs classes, wealth category effect on medicines utilization were positive and significant (0.367; 95% CI: 0.127-0.606 and 0.27; 95% CI: 0.078-0.406, respectively). However in ACEIs and Diuretics classes, wealth category effect were positive but not significant. In ARBs class, the effect of wealth on utilization was negative and not significant (-0.043; p=0.709). To estimate these medicines utilization effect, both ML and Bayesian approach indicated almost same results for all investigated classes and total medicines. CONCLUSIONS:  According to this study, an inequality related to wealth category in total antihypertensive medicines utilization between provinces could be observed in Iran. Also we observed a significant effect of total and different antihypertensive classes on systolic blood pressure of population.