Background <p>China is currently grappling with the escalating burden of hypertension and depression. This study aimed to assess the prevalence and number of hypertensive patients with depressive symptom, and to evaluate their risk of all-cause mortality.</p> Methods <p>Data from the China Health and Retirement Longitudinal Study (CHARLS) were utilized to estimate the prevalence of individuals with both hypertension and depressive symptom, the recommendation rate for antihypertensive medications, the blood pressure control rate, and the corresponding population size. The Cox proportional hazard model was employed to estimate the risk of all-cause mortality associated with hypertension combined with depressive symptom.</p> Results <p>Overall, 15.01% (95% CI: 13.80, 16.31) of adults, corresponding to 72.06&#xa0;million (95% CI: 66.91, 77.23) individuals, were identified as having both hypertension and depressive symptom. Among these, 28.49&#xa0;million (95% CI: 27.07, 29.92) were recommended to initiate blood pressure medications but did not comply. Furthermore, 19.53&#xa0;million (95% CI: 18.01, 21.06) hypertensive patients with depressive symptom who were taking antihypertensive medications did not achieve their blood pressure control goals. Hypertension combined with depressive symptom was associated with an increased risk of all-cause mortality (hazard ratio = 2.21, 95% CI: 1.48, 3.31).</p> Conclusions <p>Our findings indicated a significant population of individuals with both hypertension and depressive symptom in China, with low treatment and control rates. The coexistence of hypertension and depression was linked to a heightened risk of all-cause mortality. Strategies for hypertension prevention and treatment should be integrated with considerations for depression.</p> Clinical trial number <p>Not applicable.</p>