OBJECTIVES To examine the relationship between medication compliance, cardiovascular risk and gender in hypertensive patients visiting primary health care centers. METHODS A prospective 1-year study was conducted in rural communes in Vietnam on hypertension management in a population from 35 to 64 years. Data on age, gender, blood pressure and blood test were collected at baseline. Cardiovascular risk was based on the Cardiovascular Risk Prediction Model for populations in Asia. Medication compliance was calculated as the number of days taking the drug divided by the number of days since the first day of the prescription. A threshold of 80% was applied to differentiate between compliance or non-compliance. Taking medication was based on patients’ self-report during each monthly visit. RESULTS Of total 338 patients met the selection criteria for medication compliance study, 46% was female. Mean age was 53.5 (+/- 6.9) and 77.2 % of patients was < 10% of CVD risk in 8 years. In primary health care settings, medication compliance was 49%. No significant difference in medication compliance in both CVD risk groups (<10% vs. >10% risk) was found, also not after controlling for age and gender (adjusted OR was 1.27; 95 % CI: 0.7 – 2.2; p value 0.39). The odds of medication compliance in females was however 0.6 times higher than in males (95% CI: 0.38 to 0.95, p value 0.028). Each 1 year increase, results in patients being 1.04 times more likely to be compliant (95% CI: 1.009 to 1.076, p value 0.01). CONCLUSIONS Medication compliance rate was low among hypertensive patients in Vietnam. CVD risk at the baseline did not significantly differentiate complaint from non-compliant patients. Yet, a major difference in compliance was found for gender. Rather than risk profile, gender should be considered for guiding the choice on who to target for improving medication compliance for hypertensive patients.