The physician ability to understand non-adherence to therapy is limited and interventions by clinical pharmacist to improve compliance has effective results. However, poor compliance accounts for worsening of disease state and ultimately will increase the health care cost. The study aimed to investigate the medication adherence in hypertensive patients and the effect of counseling in a tertiary health care setting. The study was carried out in Ayub Teaching Hospital Abbottabad, KPK, Pakistan. It is a multispecialty tertiary care hospital with a modernized cardiology department. It caters to the need of both in and out patients. An assessment was made on hypertensive patients who are receiving multiple drugs were included in the study. A medication adherence questioner was prepared based on literature. Among 300 patients 205 were adherent to medication whereas 95 were non adherent and those non adherent patients were given verbal and non-verbal counseling regarding adherence to therapy. Health professionals can solve the problem of patient compliance by providing effective patient counseling. Certain technique can be adapted like motivational interviewing, teach- back method which can help to ensure patient understanding regarding the therapy.