Noncompliance has been identified as the predominant reason for failure of hypertension therapy. Patients may perceive hypertension as a symptomatic condition, and this view may affect compliance. In a cross-sectional study of outpatients attending a hypertension clinic, we assessed 125 veterans' understanding of hypertension, hypertension history, comorbidities, and pharmacy refills for hypertension medications. Though over 70% viewed hypertension as a symptomatic condition, symptoms were not significantly associated with pharmacy compliance. In univariate analyses, variables significantly associated with better pharmacy compliance were perceived lifetime treatment of hypertension, greater than 5-year history of medication use, perceived cause of hypertension other than diet, use of more than one hypertension drug, lack of reported departure from the prescribed medication regimen, absence of drug abuse history, and race (Caucasian). In multivariate analyses, the best predictive model of pharmacy compliance included three variables: drug abuse history, perceived cause of hypertension, and pattern of medication use. This type of information should be included in the assessment of medication compliance among hypertensive patients.