Introduction <p>Hypertension is a primary risk factor for cardiovascular mortality and frequently co-occurs with depression and anxiety, though their combined impact remains inadequately characterized in this high-risk population.</p> Aim <p>This study aimed to investigate the associations of depression and anxiety with cardiovascular mortality specifically in adults with hypertension.</p> Methods <p>We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire, while anxiety was measured through self-reported days. The associations were evaluated using weighted multivariable cox regression and restricted cubic spline (RCS) models.</p> Results <p>A total of 3728 participants were included, with a mean follow-up of 9.2&#xa0;years and 285 cardiovascular deaths. In Model3, depression (PHQ-9) was positively associated with cardiovascular mortality (Hazard ratio (HR) [95% CI] 1.07 [1.03–1.10], <i>P</i> &lt; 0.001). When PHQ-9 was categorized into quartiles, the greatest HR in men was observed in Q3 (2.65 [1.09–6.44], <i>P</i> = 0.032) but that for women was in Q4 (3.94 [1.39–11.2], <i>P</i> = 0.01). RCS curve revealed linear positive association between depression and cardiovascular mortality (<i>P</i>-overall &lt; 0.001; <i>P</i>-nonlinear &gt; 0.05). No interaction was observed in the stratified analyses (<i>P</i> &gt; 0.05). Sensitivity analyses showed the HR of Q4 was attenuated in the overall population but remained stable in women (3.97 [1.29–12.2], <i>P</i> = 0.019). No significant association was found between anxiety and cardiovascular mortality (<i>P</i> &gt; 0.05).</p> Conclusions <p>Depression, but not self-reported anxious days, was positively associated with cardiovascular mortality in hypertensive patients, with a stronger association observed in women.</p>