OBJECTIVES: To evaluate the gender-based differences in the quality of life (QL) and compliance (C) with routine ambulatory management of essential hypertensives (EH) living in Belarus, an European country with unique combination of the important rise in cardiovascular morbidity and mortality, highly restricted financing the state health care system, and the society experiencing socioeconomic hardships. METHODS: In 234 verified mild to moderate EH (mean age 47.8+12.2 years, 117 males, 117 females) the QL assessment was performed using the well-validated, self-administered questionnaires: The Giessen Somatic Complaints Questionnaire (GSC) and The General Well-Being Adjustment Scale (GWB). At the same time, C with previously recommended antihypertensive treatment regimens was evaluated by the standardized interview. RESULTS: The QL tests revealed significantly (Mann-Whitney) worse QL scores on all GSC and GWB subscales in the investigated Belarusian female EH compared with male ones (Gastral Complaints, Pains, Cardiac Complaints, Exhaustion, Anxiety, Depression, Well-Being, Self-Control, General Health, Vitality) with the total GSC Index (mean+SD) 35.9+17.2 vs. 21.1+13.5 points (p<0.001), and the total GWB index 76.2+15.7 vs. 87.9+17.7 points (p<0.001), respectively. The total GSC and GWB indexes were significantly (p<0.05) worse in the EH treated on regular basis (14.5% of males and 38.5% of females) compared with EH who did not treat their known hypertension. QL scores did not correlate (Spearman) with age, body mass index, office blood pressure, and duration of hypertension. In males, but not in females there was an association (ANOVA) of the total GSC index with alcohol and coffee consumption (standardized interview), while abstinents had the lowest scores (p<0.05).The high QL score, smoking, drinking and male gender were revealed as factors of poor C. CONCLUSIONS: Gender influences on the QL profile in EH living in Belarus, and relates to their C, possibly via certain life-style factors, this requiring gender-based decision making for hypertension management improvement.