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Hypertension burden in CKD: is nocturnal hypertension the primary culprit?

Francesca Mallamaci1, Claudia Torino2, Giovanni Tripepi2

  • 1Associazione Ipertensione Nefrologia Trapianto Renale (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy.

Clinical Kidney Journal
|September 10, 2025
PubMed

Insights

Nocturnal hypertension, high blood pressure during sleep, is common in chronic kidney disease (CKD) and worsens outcomes. Early diagnosis and targeted management are crucial for these high-risk patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Hypertension affects up to 90% of advanced chronic kidney disease (CKD) patients.
  • Nocturnal hypertension, characterized by lack of nighttime blood pressure dipping, accelerates CKD progression and cardiovascular risk.
  • Underdiagnosis of nocturnal hypertension is common due to limited ambulatory blood pressure monitoring.

Purpose of the Study:

  • To explore the pathophysiological mechanisms of nocturnal hypertension in CKD.
  • To review the associations between nocturnal hypertension and adverse renal and cardiovascular outcomes.
  • To discuss current and emerging therapeutic strategies for nocturnal hypertension in CKD.

Main Methods:

  • This is a narrative review of existing literature.
  • Pathophysiological mechanisms including sodium handling, volume overload, autonomic dysfunction, and RAAS dysregulation were examined.
  • Associations with left ventricular hypertrophy, proteinuria, endothelial dysfunction, and renal outcomes were synthesized.

Main Results:

  • Nocturnal hypertension is linked to accelerated CKD progression and increased cardiovascular risk.
  • Impaired sodium handling, volume overload, autonomic dysfunction, and RAAS dysregulation contribute to its development.
  • Emerging evidence connects it to left ventricular hypertrophy, proteinuria, endothelial dysfunction, and poor renal outcomes.

Conclusions:

  • Nocturnal hypertension is a clinically significant complication in CKD patients requiring diagnosis and management.
  • Comprehensive blood pressure profiling and targeted interventions, including chronotherapy, are needed.
  • Further clinical trials are essential to optimize treatment strategies for this high-risk population.

Keywords:
ABPMCKDblood pressuredialysishypertension

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