Background: Hypertension and medication adherence are global public health challenges, with elderly patients suffering the most because they frequently have multiple co-morbidities. Objective: To evaluate the level of medication adherence and perceived family support among Nigerian elderly patients with hypertension. Methods: A descriptive, cross-sectional study among 293 consecutively consenting elderly hypertensive patients using an interviewer-administered, semi-structured questionnaire. The Modified Morisky Adherence Scale (MMAS-8) and Perceived Social Support-Family Scale (PSS-Fa) tools were used to assess medication adherence and perceived family support, respectively. Results: The mean age of respondents was 69.5±6.4 years. Medication adherence was good, moderate and poor among 14.3%, 68.6%, and 17.1% of the respondents respectively. Difficulty remembering to take medications was the primary reason for non-adherence in 73.7% of cases. Good adherence to medication was significantly associated with male gender (p = 0.046), living with grandchildren (p˂0.001), having other sources of income (p = 0.026) and receiving treatment for comorbid illnesses (p = 0.025). A higher proportion of the respondents (94.9%) had strong perceived family support, which lacked statistical significance regarding good medication adherence. (p = 0.739).  Conclusion: This study found medication adherence low, despite most participants' strong family support. Forgetfulness and financial constraints were the primary reasons for poor medication adherence. Although family support is highly recommended and beneficial for medication adherence, other comorbid and social factors should be considered.