Background: Low literacy, elderly patients with chronic disease might be confused about the information of their therapy. Some country had been using pictogram (medical information in pictures) replacing the conventional one, for low literacy, elderly patients with chronic disease. East Nusa Tenggara is one of the lowest literacy province in Indonesia and hypertension is the biggest health issue in East Nusa Tenggara. Objectives: To analyze the effect of using pictogram on the improvement of adherence, measured by pill count, and blood pressure control, measured by the reduction of blood pressure (systole and diastole), in low literacy, elderly patients with hypertension. Methods: The study subjects were divided into two randomized groups, each consist of 9 patients. The test group receives pictogram.The research is done in one month with pre-test and post-test measurement The parameters used are pill countand blood pressure measurement. Outcomes: After one month, the values obtained between pre-test and post-test differ significantly in blood pressure measurement of test and control group for systole (Sig.2-tailed= 0.002; CI =0.95) and diastole (Sig.2-tailed= 0.003; CI =0.95), with values of variant analysis p = 0.2 > 0.05. However, the values obtained between pre-test and post-test differs significantly in pill count of test and control group (Sig.2-tailed= 0.004; CI – 0.95). Conclusion: The using of pictogram can reduce the blood pressure (systole and diastole) and improve patient's adherence significantly, which means provide significant improvement in blood pressure control of low literacy, elderly patients with hypertension.