Hypertension is a chronic condition requiring long-term therapy and medication adherence. Among older adults, adherence may be affected by physical limitations, regimen complexity, cognitive changes, medication beliefs, and family support. Family self-efficacy and caregiver readiness may therefore play important roles in maintaining antihypertensive medication adherence. This systematic review aimed to identify and synthesize evidence regarding the role of family self-efficacy and caregiver readiness in antihypertensive medication adherence among older adults with hypertension. A systematic review with narrative synthesis was conducted using articles retrieved from PubMed (n = 13), Scopus (n = 12), Google Scholar (n = 50), and ScienceDirect (n = 3). Studies published between [year] and [year] addressing hypertension, older adults, medication adherence, family and caregiver factors, and patient-family partnership were considered. Randomized controlled trials, observational studies, systematic reviews, and meta-analyses were included. Of 78 identified articles, 7 met the inclusion criteria and were included in the final synthesis. Family-based and self-management interventions improved medication adherence, self-efficacy, caregiver knowledge and behaviors, and blood pressure control. Observational evidence also demonstrated associations between self-efficacy, social support, and medication adherence. However, evidence directly examining caregiver readiness as a distinct construct remains limited. Family self-efficacy can strengthen caregivers' capacity to support medication adherence. Caregiver readiness may be a multidimensional construct encompassing knowledge, skills, self-efficacy, emotional readiness, communication abilities, and collaboration with patients.