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Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines; especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities; identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent; consistently non-adherent; and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent; 9 consistently non-adherent; 9 increasingly adherent; and 4 increasingly non-adherent. For the consistently adherent; positive views about prescribed medication and family support encouraged adherence. Conversely; negative views of medication and lack of family support were notable amongst the consistently non-adherent; along with resistance to accepting a ‘sick’ label. A shift toward positive views of medication was detected amongst those whose adherence improved; along with worsening health and increased family support. A decrease in financial resources drove some participants to become less adherent; especially if they already held negative views toward medication. This study sheds light on the variety of medication adherence patterns among poor people with hypertension in the Philippines; as well as the complex web of elements influencing their treatment choices. The results point to the potential for measures that address concerns about medicines and increase family support.