Relationship Between Depression, Anxiety, and Antihypertensive Medication Use Among Adults With Hypertension: A Descriptive Analysis Using the National Health and Nutrition Examination Survey (NHANES) 2013-2018

BACKGROUND: Hypertension continues to be a major public health burden, with poor blood pressure (BP) control often linked to inadequate antihypertensive medication use. Psychological factors such as depression and anxiety may further complicate treatment outcomes. OBJECTIVE: The study aimed to examine the associations between depressive symptoms and anxiety-related symptoms with antihypertensive medication use and BP control among United States (U.S.) adults with hypertension. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018 were analyzed. Adults aged ≥18 years with diagnosed hypertension were included. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9). Anxiety symptoms were defined using NHANES mental health questionnaire items that assessed the frequency of feeling nervous, anxious, or unable to control worrying over the past two weeks. Antihypertensive medication use was defined as self-reported current use of prescription medication for high BP at the time of the NHANES interview, and BP control was determined using measured values. Survey-weighted logistic regression models were used to estimate adjusted ORs and 95% CIs. The unweighted analytic sample included 3,377 hypertensive adults after excluding participants with missing data on depression score and anxiety symptoms. RESULTS: Among 46,509,348 hypertensive adults, 39,247,780 (84%) reported taking antihypertensive medication. Depression and anxiety were not significantly associated with antihypertensive medication use or BP control after full adjustment. However, antihypertensive medication use was strongly related to BP control (OR = 1.72, 95% CI: 1.25-2.35). CONCLUSION: Psychological symptoms were not independently associated with antihypertensive medication use after adjustment for demographic and clinical factors, but consistent medication use significantly improved hypertension outcomes. Integrating behavioral and clinical strategies may strengthen hypertension management in the general population.