OBJECTIVES: To describe initially-prescribed drug treatments for hypertension in newly-diagnosed recipients in a Medicaid population and to determine factors affecting 6- and 12-month persistence rates. METHODS: This retrospective study included continuously-enrolled Louisiana Medicaid recipients aged 18-64 who were newly-diagnosed with hypertension between January 2006 and December 2008.  Dually-eligible recipients were excluded.  Recipients were followed for one year after their index date.  Initial drug therapy was described, and persistence rates were calculated 6- and 12-months post-index, for recipients who received diuretics, beta-blockers (BBs), angiotensin-II receptor blockers (ARBs), angiotensin converting enzyme inhibitors (ACEIs), and calcium channel blockers (CCBs).  A 30-day grace period was allowed for refill gaps.  Race, gender, age, and co-morbidity were used as predictor variables in logistic regression analyses of persistence for each drug class. RESULTS: A total of 4946 recipients were eligible for inclusion.  Of these, 2352 received no drug therapy and 289 did not receive therapy in one of the analyzed drug classes, leaving a final study group of 2305 recipients.  The study group was primarily female (68%) and African-American (67%).  The majority of recipients received diuretics, followed by ACEIs, ARBs, BBs, and CCBs.  Persistence rates for initially-prescribed drugs ranged from 21.6% for diuretics to 31.6% for ACEIs at 6-months, and from 10.7% for diuretics to 17.9% for CCBs at 12-months.  Within drug classes, persistence ranged from 24.2% for diuretics to 33.1% for ACEIs at 6-months and 12.4% for diuretics to 19.3% for BBs at 12-months.  Race, gender, and age were significant factors predicting persistence, with African-Americans less persistent than Whites, females less persistent than males, and younger recipients less persistent than older recipients. CONCLUSIONS: Approximately half of newly-diagnosed recipients did not receive drug therapy, and among treated patients, persistence rates were poor.  Race, gender, and age were factors influencing persistence of therapy in this study group.