Assessing the Relationship Between Nocturnal Hypertension and the Risk of Cardiovascular Complications: A Systematic...

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, driven by multifactorial risk factors, including undiagnosed hypertension. Masked nocturnal hypertension (MNH), characterised by elevated night-time BP despite normal daytime levels, has been linked to increased CVD risk and hypertensive target organ damage. This systematic review and meta-analysis aim to synthesise evidence on the relationship between MNH and CVD risk.

A comprehensive search was conducted in PubMed, Web of Science, and Embase for studies published until December 20, 2025. Observational studies reporting associations between MNH and CVD risk with sufficient statistical data for meta-analysis were included. The pooled Hazard ratio (HR) was calculated using a random effect model using R software version 4.4. Heterogeneity was assessed with I² and sensitivity analyses were conducted to evaluate robustness. Study quality was assessed using the Newcastle-Ottawa Scale (NOS).

Out of 10,521 records screened, 5 studies with a sample size of over 19,000 participants were included. The studies consistently reported a significant association between elevated MNH levels and increased CVD risk. Meta-analysis yielded a pooled HR of 1.471 (95% CI: 1.008-2.147), confirming the association. No heterogeneity was observed (I² = 0%). Sensitivity analysis demonstrated the robustness of the findings.

This meta-analysis suggests a positive association between MNH and increased CVD risk, though the limited number of studies warrants caution in over-interpretation. While MNH appears to be a relevant phenotype for cardiovascular risk stratification, further large-scale prospective research is required to confirm the magnitude of this effect and its clinical utility in routine hypertension management.