Optimal blood pressure control in patients with hypertension is the key to reduced risk of developing complications, and medication adherence is an important yet often ignored factor influencing blood pressure control. This article aims to explore influencing factors and successful interventions that improve adherence to antihypertensive medication. Barriers to medication adherence are identified and a brief review of different interventions follows. Recommendations are made for promoting medication adherence in primary care practice. Barriers to antihypertensive medication adherence are manifold, and interventions to improve adherence should be individualised and tailored to address the root causes of identified barriers. In older people, cognitive impairment and depression may be prevalent yet overlooked, and primary care providers should assess medication adherence at every visit.