OBJECTIVES:  Conditions for which hospitalizations can be avoided through timely and effective outpatient care are often referred to as ambulatory care sensitive conditions (ACSC). These conditions can generally be managed effectively in a primary health care setting however the expected inverse association between primary health care access and ACSC hospitalizations is not strongly supported in the medical literature. We conducted a systematic review to assess the association between primary care access and hospitalizations and/or emergency department visits for hypertension, an ambulatory care sensitive condition. METHODS: We searched electronic databases (Medline and Embase) from inception to October 2015 to identify all observational studies evaluating the association between primary care access and hospitalizations and/or emergency department visits for patients diagnosed with hypertension. Study quality was assessed using components of the Newcastle Ottawa Scale and the Downs and Black Checklist. RESULTS:  Our search strategy yielded 4170 articles and of the 42 potentially relevant articles, three met criteria for inclusion within our review. Results and metrics used to assess this association varied substantially across the three studies. Two studies found a positive correlation between the number of primary care visits or general practitioner density and hospitalization rates for hypertension, while one study found increases in general practitioner density resulted in a reduction in hospitalization rates for hypertension. Study quality also varied with few studies adjusting for key patient- and system-level factors and severity of hypertension CONCLUSIONS:  There is limited and inconclusive evidence on the relationship between access to primary care and acute care utilization for hypertension. Further research adjusting for disease severity and key confounders is required to elucidate this relationship.