OBJECTIVES: Over a billion people globally and nearly 50 million people in US population suffer from hypertension. Evidences suggest that the initial drug of choice in clinical practice is different from JNC (Joint National Committee) guidelines. Timely treatment of newly diagnosed hypertensive patients is a key step to control the disease and hence the initial choice of drug becomes a crucial decision in the disease management. The study aims to describe the patterns of drug therapy initiation among newly diagnosed hypertensive patients and to compare the patterns between different hypertension severities. METHODS: The study is a retrospective analysis of newly diagnosed hypertension patients with SBP (systolic blood pressure) °Ý140mmHg, or DBP (diastolic blood pressure) °Ý90mmHg, with no recent history of hypertension and no compelling co-morbidities. Newly diagnosed hypertensive patients were identified with high blood pressure in medical records along with no existence of hypertension drug therapy in the one year prior to the initial drug therapy. Drugs in pharmacy claims were identified using a proprietary drug database. RESULTS: A total of 169 patients were identified as study sample comprising of 88 males and 81 females. The percent who had stage 1 hypertension was 37.47% (64 patients). Diuretics was most frequent initial drug of choice in patients with stage 1 hypertension (45.32%, 95% CI: 37.81-52.82%) and in stage 2 hypertension (46.67%, 95% CI: 39.14-54.19%). Monotherapy was preferred over combination therapy in stage 1 hypertension patients (87.5%, 95% CI: 82.51-92.48%). Monotherapy was still preferred over combination therapy in stage 2 (73.34%, 95% CI: 71.23-80.00%) hypertension. CONCLUSION: Differences still exist in clinical practice and JNC guidelines with regards to initial drug of choice in newly diagnosed hypertensive patients with no compelling indications. More emphasis.