Three candidates were on the ballot in the first round, held on 21 April: Stevo Pendarovski, supported by the ruling coalition led by the Social Democratic Union of Macedonia, including the Democratic Union for Integration;[1] Gordana Siljanovska-Davkova of the leading opposition party VMRO-DPMNE, and Blerim Reka, an independent supported by Albanian opposition parties Alliance for Albanians and Besa Movement.

[3] Incumbent President Gjorge Ivanov was constitutionally barred from seeking a third term in office, having previously been elected in 2009 and 2014.

Incumbent President Gjorge Ivanov was a vocal opponent of the name change and refused to sign the laws and amendments on the matter.

[5] After her nomination, VMRO-DPMNE candidate Gordana Siljanovska-Davkova had promised to initiate a second referendum and restore the old name to the country if she won.

However, the XXXI amendment approved on 9 January 2009 lowered the threshold to 40%,[8] as the then-government feared the trend of reducing turnouts would lead to presidential elections being frequently invalidated.