BACKGROUND: Psychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m OBJECTIVES: To determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS). SETTING: Academic medical center. METHODS: Outcomes were identified from electronic medical records. Psychiatric diagnoses were assessed by clinical interview and included any bipolar and related disorder or depressive disorders, anxiety, alcohol use disorder, substance use disorder, post-traumatic stress disorder, and eating disorders. Adjusted odds ratios for the association between psychiatric diagnoses and hypertension and uncontrolled BP, separately, were calculated using logistic regression. Linear regression was used to determine the association of psychiatric diagnoses with SBP. Models were adjusted for age, sex, race, and BMI. RESULTS: There were 281 participants with mean age of 40.5 years (standard deviation = 10.9) and BMI of 45.9 kg/m CONCLUSIONS: A diagnosis of anxiety during the lifetime of patients undergoing MBS was associated with almost three times increased odds of hypertension.