This article used the data of hypertension patient management in Tianchang City and selected 525 cases of permanent residents aged 35 and above who were newly included in the hypertension patient management in Tianchang City in 2023 as the research objects. The analysis employed propensity score matching （PSM）to study the impact of free medication on the follow -up effect of hypertension patients，thus providing insights for adjusting the free chronic disease medication distribution policy in Tianchang City. The results showed that the average treatment effect of free medication on medication adherence，psychological adjustment， and compliance behavior of hypertensive patients in Tianchang were -0.308，-0.095 and -0.112，respectively， indicating a significant positive effect. However，the effect on blood pressure control was not significant. Overall，actively encouraging free medication will be beneficial to promoting the health management of hypertension patients in Tianchang City. At the same time，relevant departments such as the Tianchang Health and Welfare Commission should also enhance policy advocacy，optimize the types and distribution methods of free chronic disease medications，and ensure a stable drug supply，to better implement the free chronic disease medication distribution policy in Tianchang City.