Despite the availability of effective medications, hypertension remains inadequately managed in the United States. It has been established that medication adherence is a major strategy for controlling blood pressure. Combined interventions to promote adherence are promising, but further research is needed to understand which behaviors to target. The frequency of self-monitoring of blood pressure among municipal workers is unknown, and the literature is limited regarding assessing individuals' readiness and confidence to engage in medication adherence. The purpose of this study was to determine the prevalence of medication adherence, readiness, self-efficacy, self-monitoring of blood pressure, and blood pressure control among hypertensive municipal workers. The study population was enrolled in a wellness program established more than 20 years ago to promote health and safety for a work force in a large southeastern U.S. city. The majority of the study participants (75.7%) demonstrated controlled blood pressure, reported adherence to antihypertensive medication (70%), and self-monitored blood pressure (70%).