Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 3 2026 05 06 290 307 Ronald Pratama Adiwinoto Department of Public Health, School of Medicine, Universitas Hang Tuah Saptono Putro School of Medicine, Universitas Hang Tuah Tamam Jauhar Department of Pharmacology, School of Medicine, Universitas Hang Tuah Kellyn Tricia Zenjaya Undergraduate Study Program, School of Medicine, Universitas Hang Tuah Dinnara Nelya Rindayu Undergraduate Study Program, School of Medicine, Universitas Hang Tuah Lidya Prillyarista Herlambang Undergraduate Study Program, School of Medicine, Universitas Hang Tuah I Made Dwi Mertha Adnyana Department of Indonesian Traditional Medicine, School of Health, Universitas Hindu Indonesia; Indonesian Society of Epidemiologists; Royal Society of Tropical Medicine and Hygiene 2025 01 26 2025 10 14 Introduction: Adherence to hypertension medication remains a critical challenge in healthcare management, particularly in resource-limited settings. This study investigated the determinants of medication adherence among patients with hypertension in Indonesian primary healthcare settings. Methods: A cross-sectional study involving 96 hypertensive patients selected through systematic random sampling was conducted at the Public Health Center of Tenggilis, Surabaya. Data were collected via validated questionnaires, including the Morisky Medication Adherence Scale-8 (MMAS-8), and analyzed via multivariate logistic regression. Results: Among the 96 hypertensive patients included in this study, the majority were aged 40–49 years (30.2%), with a male predominance (67.7%). Most participants had a senior high school education (57.3%) and were employed as civil servants (30.2%). Only 52.1% of patients reported consistent medication adherence, with financial barriers and knowledge gaps identified as the primary challenges. Multivariate logistic regression analysis revealed that regular medical control (odds ratio [OR] = 1.963, 95% CI 1.214-3.181; p = 0.006) and alternative diagnostic methods (OR = 2.326, 95% CI 1.532- 3.538, p<0.001) were significantly associated with better medication adherence. Adherence to doctors' advice (OR = 1.699, 95% CI 1.128–2.559, p = 0.012), the ability to manage medication costs (OR = 1.518, 95% CI 1.012–2.278, p = 0.044), and routine treatment management (OR = 1.825, 95% CI 1.219–2.736, p = 0.004) were identified as key predictors of positive medication adherence. Conclusion: Medication adherence in patients with hypertension is influenced by multiple factors, including diagnostic approach, healthcare access, cost management, and routine treatment compliance. These findings emphasize the need for comprehensive interventions that address both clinical and socioeconomic barriers to improve hypertension management in primary healthcare settings. https://jbe.tums.ac.ir/index.php/jbe/article/view/1585