OBJECTIVES: To compare the number of antihypertensive medications that were approved by the US Food and Drug Administration, the UK Medicines and Healthcare Products Regulatory Agency, the Australian Therapeutic Goods Administration, Health Canada, and the Saudi Food & Drug Authority as of [2014].  METHODS: Antihypertensive medications information was collected from the websites of the agencies. Hypertension prevalence by country was collected from the WHO website. Descriptive analysis was conducted in the study.  Spearman correlation was used to estimate the correlation between the number of approvals and hypertension prevalence.  SAS version 9.3 was used in the analysis. RESULTS: The prevalence of hypertension in 2008 varied by country (US=15.6%, UK=23.4%, Australia=18.2%, Canada=15.3%, and Saudi Arabia=31.2%). There were 138 antihypertensive medications and 61 combinations available in all five countries. The US had the highest number of antihypertensive medications (70.0%), followed by Canada (56.5%), UK (52.8%), Australia (51.44%) and Saudi Arabia (49.2%). There were 31 combinations of antihypertensive medications with the FDA listing 50.8% of those combinations, followed by the UK (40.9%), Saudi Arabia and Australia (both 37.7%), and Canada (34.4%).The therapeutic classes with the larger number of approvals were beta blockers (n=14), angiotensin-converting enzyme inhibitors (n=11) and thiazide diuretics (n=11). The relationship between the number of antihypertensive drugs approved and hypertension prevalence appeared inverse, (Spearman correlation coefficient= -0.8), yet non-significant (P=0.10), most likely due to lack of power (n=5) and the ecological nature of this correlation.  CONCLUSIONS: Differences exist in the number of antihypertensive medications and therapeutic classes available in each country.  The US had the highest access to antihypertensive medications among the countries included in the study. Further studies are needed to assess the utilization of antihypertensive medications and the potential relationship with hypertension prevalence.