Objectives: African Americans (AA) suffer excess hypertension-related health outcomes and their blood pressures (BPs) are widely reported to be less controlled than European Americans (EA). Intensity of hypertension treatment may play a role. We examined whether AA with treated hypertension received less-intense medication regimens than EA, as reflected in the number of antihypertensive medication classes. Design: Cross-sectional observation of baseline information from the REasons for Geographic And Racial Differences in Stroke cohort. Participants were recruited by telephone in 2003-2005, completed a telephone survey, and had BP measured and medications recorded during an in-home visit. The study's outcome was the number of classes of antihypertensive medications. Setting: US national cohort study with over-sampling from high stroke mortality regions. Participants were self-identified AA or EA, ≥45 years old, living in the community, and balanced on AA race and sex by design. Participants: 8960 individuals with treated hypertension. Results: Mean age was 68.0 ± 8.6 years. AA were poorer and less educated than EA, and had worse BP control (63.5% BP<140/90 mm Hg for AA, 74.0% for EA, P<.01), yet they were on more classes of BP medication (24.1% on ≥3 classes, vs 16.9%, P<.01). AA were taking an average of 0.138 more antihypertensive medication classes than otherwise similar EA (P<.01). More intense treatment persisted across all age, sex, education, income and BP groups. Conclusions: AA were more intensely treated for hypertension than EA. Further study to identify action strategies to eliminate racial differences in hypertension outcomes is warranted.