OBJECTIVES: To measure and compare the extent of medication compliance in elderly and geriatric hypertensive cohorts. To evaluate the role of illness perceptions and investigate how medication beliefs and dimensions of illness perceptions, might impact medication compliance outcome in hypertension.  METHODS: A cross-sectional research design, utilizing convenience sampling strategies and self-administered surveys of elderly hypertensive residents living in New York City senior care centers (N=117). Medication compliance was measured using Morisky’s test; medication beliefs were measured using Beliefs about Medication Questionnaire (BMQ), and illness perceptions using Brief Illness Perceptions Questionnaire (BIPQ).   RESULTS: MajoriMajority of the population was white (75%).  There were no significant differences observed demographically between the elderly (55-65 years) and geriatric (65+ years) samples except with respect to college education (53% vs. 47%). About 46% of the elderly sample was noncompliant with hypertension medications, compared to 63% who were 65 years and older (geriatric). BIPQ component scores correlated positively with medication compliance score across both elderly and geriatric samples (r= 0.134; p=0.496 and r= 0.447; p=0.000, respectively). The score on Specific Necessity Beliefs dimension associated positively with Morisky’s Test score across both the cohorts (r=0.027, p=0.892 and r=0.297; p=0.020), whereas General Harm and General Overuse Beliefs about medication correlated negatively with medication compliance. A majority of the participants rank-ordered stress as the number one cause of their illness (49.1%), followed by ‘lifestyle’ (43.8%) and ‘hereditary factors’ (7.1%).  CONCLUSIONS: Medication noncompliance seems to worsen with an increase in age. Stronger necessity beliefs and more favorable perceptions about the illness are observed in geriatrics compared to elderly. The study underscores the importance of incorporating patient perceptions about illness and medication beliefs into disease management frameworks that seek to build medication compliance in hypertension.