Morning Hypertension as a Factor Independently Associated with Renal Dysfunction in Hypertensive Patients with Chronic Kidney Disease.

Morning hypertension was present in 42.4% of hypertensive CKD patients, and nocturnal hypertension was present in 78%.

• 132 patients with CKD stages 1-5 underwent 24-h ABPM, transthoracic echocardiography, and biochemical evaluation.
• Morning and nocturnal hypertension were defined according to ESC 2024 guidelines.

Patients with morning hypertension had significantly lower eGFR and higher UACR than those without.

• Both differences were reported at p < 0.001.
• Demographic, clinical, echocardiographic, and renal parameters were compared between groups.

Morning hypertension correlated positively with creatinine, urea, PTH, ESR, and UACR, and negatively with eGFR, albumin, calcium, hemoglobin, and TAPSE.

• Correlation analyses were performed to explore associations between blood pressure phenotypes and markers of target organ damage.
• The negative correlation with TAPSE suggests an association with right ventricular longitudinal function.

In multivariable regression, morning hypertension was independently associated with lower eGFR.

• Reported β = -0.26; p = 0.002.
• Multivariable regression models were used to assess independent predictors of renal and cardiac structural alterations.

Nocturnal hypertension was positively associated with interventricular septal thickness (IVSd) and with UACR.

• For IVSd, β = 0.19; p = 0.024.
• The authors interpret this as supporting a role for nocturnal hypertension in cardiac remodeling and renal injury.

The authors conclude that morning hypertension may be a clinically relevant BP phenotype in CKD, but its prognostic significance requires longitudinal study, and ABPM may enhance risk stratification.

• The study design was cross-sectional, so associations with renal dysfunction do not establish prognosis.
• The authors suggest incorporating ABPM into routine practice to guide individualized treatment strategies in CKD.