Objective: Metabolic syndrome results from a complex interaction between lifestyle and genetic factors. Among this population, adhesion to healthy recommendations is a cornerstone of cardiovascular disease prevention. We examined the association between depression and multiple unhealthy behaviours in hypertensive patients with the metabolic syndrome. Research design and methods: Eight hundred and forty consecutive hypertensive subjects with the metabolic syndrome were studied in our secondary-care centre. Separated scores reflecting unhealthy behaviours(physical inactivity, smoking and unhealthy diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale was used to assess and quantify depression. We performed a separate analysis for each sex. Results: The prevalence of depression(13.0 versus 7.3%, P< 0.001) was greater in women than in men. Presence of depression was significantly associated in both men and women with unhealthy diet(in particular, excessive cholesterol and total caloric intake) but also with decreased physical activity in men and with smoking habits in women. In both sexes, the global unhealthy lifestyle score, reflecting a cluster of unhealthy behaviours, was positively correlated with the depression score. In multivariate analysis, the depression score appeared in both sexes as an independent determinant of unhealthy lifestyle. Conclusions: Among hypertensive subjects with the metabolic syndrome, depressive symptoms along a continuum of severity are independently associated with multiple unhealthy lifestyles. This suggests that even minor forms of depression may impact on adhesion to health behaviours beyond major depressive symptoms and/or psychiatric condition. Objective: Metabolic syndrome results from a complex interaction between lifestyle and genetic factors. Among this population, adhesion to healthy recommendations is a cornerstone of cardiovascular disease prevention. We examined the association between depression and multiple unhealthy behaviors in hypertensive patients with the metabolic syndrome. Research design and methods: Eight hundred and forty consecutive hypertensive subjects with the metabolic syndrome were studied in our secondary-care center. Separated Nouns Anxiety and Depression scale was used to assess and quantify depression. We performed a separate analysis for each sex. Results: The prevalence of depression (13.0 versus 7.3%, P <0.001) was greater in women than in men. Presence of depression was significantly associated in both men and women with unhealthy diet (in particular, excessive cholesterol and total caloric intake) but also with decreased physical activity in men and with smoking habits in women. In both sexes, the global unhealthy lifestyle score, reflecting a cluster of unhealthy behaviors, was positively correlated with the depression score. In Multivariate analysis, the depression score appeared in both sexes as an independent determinant of unhealthy lifestyle. Among these hypertensive subjects with the metabolic syndrome, depressive symptoms along a continuum of severity are independently associated with multiple unhealthy lifestyles. This suggests that even minor forms of depression may impact on adhesion to health behaviors beyond major depressive symptoms and / or psychiatric conditions.