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The purpose of this study was to determine if prescribing patterns for anti-hypertensive medications among members of the largest medical insurer in the State of Hawai'i were consistent with the JNC 7 Guidelines and Recommendations. The design was a retrospective observational study. The study sample consisted of 108,167 members diagnosed with hypertension (HTN), who lived in Hawaii, and who were prescribed at least one anti-hypertensive medication between the years 1999-2002. Adherence to a prescribed medication was measured using pharmaceutical claims and was based on a medication possession ratio. A ratio of 0.8 or greater was considered adherent. Adherence was examined descriptively and analyzed using multivariable logistic regression models. For all four disease categories the largest percentage of prescriptions in the first year of anti-hypertensive medication use were for calcium channel blockers (CCB) and ace inhibitors (ACEI), specifically: Beta blockers (BB) were prescribed to about 20% of the members for all 4-disease categories. By contrast, thiazide diuretics (TD) were prescribed to less than 15% of the members in any disease category. In logistic regression models including the 9 drug classes, members taking TD (alone or in combination) had the lowest adherence. Members taking ACEI, CCB, and BB had the highest. Members aged 50 and over were about twice as likely to be adherent as members aged 18-39. There is some indication that the study sample was not necessarily prescribed anti-hypertensive medications consistent with JNC 7 recommendations for HTN management and control. This study is supported by NCRR grant RR-03-007, “Clinical Research Education and Career Development (CRECD) in Minority Institutions.”