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Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence. Objective. Explore the effects of emotional response (ER) on adherence to antihypertensive medication and on systolic blood pressure (SBP) improvement. Design. We studied 101 adults with diabetes and hypertension. The primary outcome, 90‐day “percentage of days covered” adherence score, was determined from pharmacy refill records. The secondary outcome was change in SBP over 90 days. ER was classified as positive, negative, or neutral. Results. Average adherence was 71.6% (SD 31.4%), and negative and positive ER were endorsed by 25% and 9% of subjects, respectively. Gender moderated the effect of positive or negative versus neutral ER on adherence (interaction P = 0.003); regardless of gender, negative and positive ER were associated …