Hypertension, the leading cause of mortality and the third largest cause of disability, is poorly controlled worldwide. The failure to control hypertension takes an unacceptable toll on patients and their families. In addition to the personal cost, to the individual patient, uncontrolled hypertension creates huge, avoidable economic burdens when viewed in terms of the general population. Almost one-half of patients drop out entirely from treatment within 1 year. This review summarizes key challenges related to hypertension management with special focus on patient compliance. Firstly, we will present consequences of poor blood pressure control. Secondly, methods of patient compliance assessment will be reviewed. Thirdly, we will present recent studies assessing adherence with hypertension treatment. Finally, we will review potential solutions to improve patient compliance and blood pressure control which are of crucial importance for reduction of hypertension-related morbidity and mortality.