Background: Uncontrolled blood pressure has been strongly associated with inadequate health literacy, emerging as a new risk factor for heart diseases. Improving health literacy among those at highest risk is a challenge to healthcare providers and health systems. And to assess health literacy conditions of patients with hypertension on initial health care services (primary and secondary health care) may improve outcomes and self management.

Objective: To analyze the health literacy conditions of users of the Brazilian Unified Health System with arterial hypertension at services of different levels of complexity.

Methods: Cross-sectional study. Data were collected from 435 individuals with arterial hypertension treated in a primary healthcare and a secondary healthcare service, in two cities of Brazil, using the Brazilian version of the Health Literacy Questionnaire (HLQ-Br). Demographic and health service data were also collected. Data were analyzed using descriptive statistics, the mean scores of the HLQ scales and non-parametric tests for measures of association of health literacy.

Results: Most individuals were female in both services. About half of the group reported income up to three minimum wages; time of treatment in the service was longer than 48 months and time of diagnosis of the disease longer than 36 months. They use up to four medications to treat high blood pressure and attend up to three consultations a year. HLQ-Br scores indicated differences between both services in six of nine scales, except “Feeling understood and supported by healthcare providers”, “Having sufficient information to manage my health” and” Social support for health”. Mean scores were influenced by gender, age, education, cohabitation, work, income, number of medications and consultations, self-reported health status, length of treatment and diagnosis.

Conclusions: In both settings healthcare providers have to base their professional communication appropriately (teaching and explanations of treatment). There is no perfect health care model, but one that presents better results in the population's health and offers equity in care. Further studies are needed to identify strategies that invest in promoting users' empowerment and participation, improving skills that enable patients with hypertension to obtain, better understand and use information to manage their condition.