OBJECTIVES: Poor adherence to medications is widespread especially in the treatment of chronic conditions such as hypertension leading to poor health outcomes and huge medical spending on drug-related morbidity.Treatment of hypertension is multifaceted, requiring long-term compliance with both medication regimens and behavior modifications. This study was conducted to assess medication adherence in hypertensive patients with comorbidities. METHODS: An observational study was conducted at Warangal. We included 231 hypertensive patients in our study, categorized into four groups. Group A (only HTN), group B (HTN with DM), group C (HTN with CVA) group D (HTN with CHD). A retrospective medication record review was conducted to collect and confirm data on patient’s diagnosis and treatment. The Hill-bone compliance to high blood pressure therapy scale was used to assess patient behavior for hypertension treatment. RESULTS: Association between comorbidities and medication adherence was statistically significant only with group C. Group C (HTN with CVA) patients had higher odds of medication non-adherence (OR 2.48, 95% CI: 1.17to 5.23) compared with group A (only HTN) patients. Group B (HTN with DM) and group D (HTN with CHD) patients with OR for medication non-adherence at 1.41 (95% CI: 0.66 to 2.98) and 0.614 (95% CI:0.26 to 1.41) respectively were non-significant when compared with Group A (only HTN) patients. CONCLUSIONS: Good adherence was observed in overall study patients. The association between comorbidities and medication adherence was statistically significant only in hypertensive patients with CVA. Hypertensive patients with CVA appear to have least average medication adherence unlike other comorbid hypertensive population.To achieve good adherence, strong and effective patient education is required for hypertensive patients with CVA.