Despite evidence for the benefits of treating hypertension in old age, only a small number of elderly patients have adequate blood pressure control. The reasons are complex and include a combination of factors related to physician, patient adherence to therapy and properties of the antihypertensive drugs. Substantial gaps have been documented between the development and dissemination of recommendations and their implementation in practice. Older patients are more likely to have difficulty with medication adherence. Better compliance achievement among the elderly patients should include a complex strategy. Moreover, physician information strategies must be improved.