Stage 2 hypertension is a major risk factor for cardiovascular events and should be treated adequately. Despite the importance of patient health literacy in hypertension management, data from patients living in rural areas are lacking. Objective: This study aimed to measure health literacy levels among patients with stage 2 hypertension in Dlingo subdistrict, Yogyakarta. A crosssectional observational study was conducted in August-September 2019. Participants (N=108) were members of the Posyandu lansia, aged 45 years or more who were diagnosed with stage 2 hypertension at least 6 months before this study began. The Indonesian Rapid Estimate of Adult Literacy in Medicine (REALM) questionnaire (score range 0-11) and three screening questions (SQs) were used to assess the level of health literacy. All participants had a low level of formal education; none had graduated from junior high school. Most participants (85%) were categorized as having low literacy (REALM score 6). The average REALM score was 2.3 ± 3.3, and 64 patients (59%) had a score of 0. Only 20% of patients felt confident enough to complete health-related forms (SQ1), 77% perceived problems in understanding written materials (SQ2), and 61% needed some assistance for reading health information (SQ3). A higher level of formal education and younger age were associated with a higher REALM score (p<0.05). Inadequate health literacy is common among patients with hypertension living in rural areas. Tailored intervention strategies to increase the understandability of health information are needed.