OBJECTIVES: Medication adherence among hypertensive patients is poor stemming from various factors. The aim of this review was to appraise published randomized control trials (RCTs) on hypertensive patients to determine the effectiveness of a pharmacist led intervention for improving medication adherence and blood pressure control. METHODS: Only English language RCTs published between January 1st, 1995 and December 31st, 2013 were considered for inclusion. Electronic databases searched included: PubMed, Web of Science, Elsevier, CINAHL, and Google Scholar. Studies were eligible if they comprised a separate group of controls. The intervention, pharmaceutical care or counseling provided by a pharmacist, had to be compared with the usual treatment for hypertension or a combination of usual treatment and sham interventions. Only studies that compared outcomes after at least a six month follow up period using at least one or a combination of the following for assessing adherence: pill count, medication refill rate, or a validated adherence scale were included. RESULTS: Of 457 citations reviewed, 9 RCTs met the inclusion criteria. The included RCTs were conducted in various parts of the world, including China, Brazil, Portugal and the United States. Across the 9 RCTs, a total of 581 individuals for the intervention group and 587 individuals in the control group were compared in the analyses. The outcome measures were systolic and diastolic blood pressure, and medication adherence assessed using a validated tool. The results showed that for the intervention group, which received pharmaceutical care services, there was a significant decline in systolic and diastolic blood pressure and improved medication adherence from baseline, in comparison to the control group. CONCLUSIONS: Pharmaceutical care may improve adherence and blood pressure control in hypertensive individuals. The evidence supports the wider provision of pharmaceutical care for hypertension management in various practice settings.