This article uses the data of hypertension patient management in Tianchang City, selects 525 permanent residents aged 35 and over who were newly included in hypertension patient management in Tianchang City in 2023 as the research object, and uses propensity score matching (PSM) to study the impact of free medication on the follow-up effect of hypertension patients, thus providing a reference for the adjustment of free chronic disease medication distribution policy in Tianchang City. The results showed that the average treatment effect of treated (ATT) of free medication on medication adherence, psychological adjustment, and compliance behavior in the treatment group of hypertensive patients in Tianchang were -0.308, -0.095, and -0.112, respectively, indicating a positive effect and significant 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 Tianchang Health and Welfare Commission should strengthen policy publicity, optimize the types and distribution methods of free chronic disease medications, and ensure drug supply, so as to better implement the free chronic disease medication distribution policy in Tianchang City.