Background: There is debate about associations of adherence to antihypertensive medications with anxiety, depression, and stress. Studies in relationship between depression, anxiety, and stress with antihypertensive medications adherence among primary health care (PHC) patients in Egypt are limited.

Objective: To assess the relationship of depression, anxiety, and stress with antihypertensive medications adherence among hypertensive patients attending PHC settings in Port Said governorate.

Methods: This cross-sectional study included 477 hypertensive patients. Data was collected by using a questionnaire which consists of 6 parts: socioeconomic characteristics, disease profile and blood pressure control, the Patient Health Questionnaire 9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the 8-item Morisky Medication Adherence Scale (MMAS-8).

Results: The prevalence of depressive symptoms was 33.8%, while the prevalence of generalized anxiety symptoms was 28.9%. High adherence was demonstrated in 25.8% of the participants, and the mean of perceived stress symptoms was 18.51 ± 6.647. Adherence to antihypertensive medication had weak negative correlations with symptoms of depression, anxiety, and perceived stress (rho= -0.218, rho= -0.269, rho= -0.396, p<0.001, respectively). Logistic regression analysis found that medication adherence was positively associated with controlled hypertension (OR 1.961, p=0.002), absent depressive symptoms (OR 2.539, p=0.001), and lower PSS10 total score (OR 0.823, p<0.001).

Conclusion: Antihypertensive medication adherence was inversely associated with symptoms of depression and perceived stress. Longitudinal research is needed to assess the casual relationship between these issues in Egypt.

Keywords: Adherence, Anxiety, Depression, Hypertension, Perceived stress.