OBJECTIVES: To evaluate doctors’ adherence to Malaysian Clinical Practice Guidelines on management of hypertension (CPG 2008) in patients with cardiovascular disease, and factors associated with guidelines adherence and hypertension control. METHODS: This was a cross sectional study conducted at outpatient cardiology clinic of Penang Hospital. A total of 13 doctors practicing in the clinic were enrolled in the study. Prescriptions written by each doctor to 25 established hypertensive patients with cardiovascular disease (total 325) were noted on visit 1 along with patients' demographic and clinical data. Implicit review of patients’ medical record was conducted to find acceptable rationale for nonadherence to guidelines. The prescriptions written were categorized either as adherent or non-adherent to CPG (2008). Two hundred sixty of the enrolled 320 patients (20 out of 25 patients enrolled per doctor) were followed for another one visit. Blood pressure readings noted on visit 2 were related to prescriptions written on visit 1. SPSS 16 was used for data analysis. RESULTS: One hundred ninety-one (73.5%) patients received guidelines compliant pharmacotherapy. CPG compliance had statistically significant weak negative association with left ventricular hypertrophy (LVH) (Φ= -0.241, P<0.01), and diabetes (Φ= -0.228, P<0.01). One hundred fifty-four (59.2 %) patients were on goal BP. Hypertension control had statistically significant weak positive association with guidelines adherence (Φ=0.175, P<0.01), and Angiotensin converting enzyme inhibitors (Φ=0.195, P<0.01), while weak negative association with diabetes mellitus (Φ=-0.148, P=0.017), left ventricular hypertrophy (LVH) (Φ=-0.153, P=0.017) and monotherapy (Φ=-0.168, P<0.01). CONCLUSIONS: Adherence to guidelines resulted in better hypertension control. Overall prescribing practices were in fair compliance with guidelines but room for further improvement is still present. Doctors’ poor adherence to guidelines in patients with diabetes mellitus and LVH needs further probing and focus in future.