Patient adherence to antihypertensive medication is an important strategy for blood pressure control in hypertensive patients. However, rates of antihypertensive medication adherence among hypertensive African-Americans are unacceptably low. This article examines the current understanding of patient, clinical, provider and healthcare system factors associated with medication adherence in hypertensive African-Americans. Studies demonstrated that patient and clinical factors, such as self-efficacy and depression, are consistently associated with medication adherence in hypertensive African-Americans patients. Provider communication shows promise as a correlate of medication adherence, but more research on provider and healthcare system factors are still needed. The authors recommend that interventions targeted at increasing medication adherence among hypertensive African-Americans focus on self-efficacy. It is also imperative that clinicians screen hypertensive patients for depression and treat, if necessary.