OBJECTIVES: Good adherence to long term management of chronic diseases such as hypertension is very vital in order to prevent long term mortality and morbidity. There are many factors associated with non-adherence to prescribed medications and one of it is lack ok knowledge and awareness among patients towards the disease they are suffering from. The aim of the present study is to evaluate the association between patient’s knowledge to hypertension disease state management and medication adherence.   METHODS: A cross-sectional study was undertaken with 385 established hypertensive patients who visited out patient departments in two public hospitals of Quetta city, Pakistan. Besides the demographic and disease-related questions, two questionnaires (Hypertension Fact Questionnaire with 15 items for knowledge and Drug Attitude Inventory with 10 items) were used for data collection. Descriptive statistics and Spearman correlation were carried out by using SPSS version 16. RESULTS: Out of 385 patients (68.8% male; mean age: 39.02 ±6.596), 236 (61.3%) of the patients had moderate degree of knowledge about hypertension. A total of 249 (64.7%) were categorized as poor adherent. Noticeably no patient was considered as good adherent in the study. Correlation coefficient between total score of knowledge and total adherence was – 0.170 (P<0.001) indicating an inverse association between knowledge scores and adherence level. CONCLUSIONS: Patient knowledge about hypertension had weak relation with drug adherence in this cohort of study group. This is possibly due to the dominancy of other factors influencing drug adherence such as perception of patients towards disease and drug, income, education, age etc in this cohort of study group. This calls attractive opportunities for further research on drug adherence and also identifies the gaps in providing optimum health care to patients.