Aim Gaining an insight into the utilization of antihypertensive medicines against a background of evolving hypertension treatment guidelines that might not be relevant to the oldest old is important. The aim of the present study was to characterize the overall trends in the utilization of antihypertensive medicines in the oldest old by therapeutic class and chemical type, stratified by age and sex over a decade. Methods Antihypertensive medicines utilization was examined using the therapeutic and chemical groups based on the World Health Organization Collaborating Center for Drug Statistics Mythology's Anatomical Therapeutic Chemical classification system for all individuals aged ≥80 years. Regression and repeated cross‐sectional analyses was carried out, and defined daily dose was used to describe the utilization per thousand older people per day. Results Utilization of antihypertensive medicines increased over the decade from 187.28 in 2005 to 205.01 defined daily dose per thousand older people per day in 2014, and shifted from mainly diuretics to angiotensin‐converting enzyme inhibitors. Interestingly, with the exception of diuretics, utilization of all medicines decreased gradually with increasing age. Single products use increased by 1.48‐fold in 2014 compared with 2005, and for fixed‐dose combinations the increase was 1.41‐fold for the same period. Conclusions The increased utilization of angiotensin‐converting enzyme inhibitors is consistent with recommendations from cardiovascular guidelines formulated from large randomized control trials that often exclude the oldest old. Interestingly, the utilization of beta‐blockers decreased and diuretics increased in centenarians. The utilization of calcium channel blockers and angiotensin‐converting enzyme inhibitors across the study period increased in all age categories. Geriatr Gerontol Int 2016; ••: ••–••.