Objective <p>A significant correlation has been discovered between illness perception and quality of life, but the relationships among illness perception, medication experience, and quality of life remain to be confirmed. Therefore, this study aims to identify the relationship between illness perception and quality of life among Chinese rural elderly patients with hypertension and to analyse the possible mediating role of medication experience between these two aspects.</p> Methods <p>From September to December 2023, a cross-sectional study was conducted to select rural elderly patients with hypertension by multi-stage stratified random sampling. Data was collected using the brief illness perception questionnaire, the grassroots medication experience scale for patients with chronic diseases and the quality of life scale. Multiple linear regression and Bootstrap method were used to explore the mediating role of medication experience between illness perception and quality of life.</p> Results <p>A total of 846 patients met the inclusion criteria. The mean scores of illness perception, medication experience and quality of life at baseline were 4.85 ± 1.04, 4.13 ± 0.52, 4.37 ± 0.37, respectively. The result of <i>Spearman</i> correlation analysis showed that the illness perception was negatively correlated with medication experience (<i>r</i> = -0. 359, <i>P</i> &lt; 0.01) and quality of life (<i>r</i> = -0. 317, <i>P</i> &lt; 0.01), and medication experience was positively correlated with quality of life (<i>r</i> = 0. 511, <i>P</i> &lt; 0.01). The results of mediating effect test indicate that medication experience had a partial mediating effect on the relationship between illness perception and quality of life among rural elderly hypertensive patients, and the mediating effect accounted for 54.21%.</p> Conclusions <p>Our findings revealed that illness perception not only directly influenced quality of life among rural elderly hypertensive patients but also indirectly via medication experience. Illness perception is a negative factor affecting the quality of life of rural elderly patients with hypertension, while medication experience is a protective factor. Therefore, medical institutions should strengthen health education to improve their illness perception of hypertension. The pharmaceutical service ability of rural medical institutions should be improved to improve the medication experience of hypertensive patients.</p>