Aim To observe the status of nocturnal hypertension (NH) in young and middle-aged hypertensive patients, explore its influencing factors, and provide reference for clinical work. Methods A cross-sectional study method was adopted to collect the clinical data of young and middle-aged hypertensive patients who visited Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2021 to April 2022, including general clinical data, biochemical test indicators, and 24-hour ambulatory blood pressure monitoring data and Pittsburgh sleep quality index score. According to NH diagnostic criteria, 268 hypertensive patients were divided into non-NH group and NH group. The data of the two groups were analyzed and compared. Results Among 268 young and middle-aged hypertensive patients, 47 cases were in the non-NH group and 221 cases were in the NH group, with NH accounting for 82.46%. Nocturnal average blood pressure, daytime average blood pressure and 24-hour average blood pressure in the NH group were higher than those in the non-NH group. Among them, the nocturnal systolic blood pressure, nocturnal diastolic blood pressure, daytime systolic blood pressure, daytime diastolic blood pressure, 24-hour mean systolic blood pressure and 24-hour mean diastolic blood pressure in the NH group were 1.0,1.1,1.8,1.2,1.16 and 1.14 times that of the non-NH group, respectively (P＜0.01). The magnitude of drop in nocturnal blood pressure in the NH group was smaller, and the magnitude of drop in systolic blood pressure and diastolic blood pressure was only 40.02% and 43.43% of that in the non-NH group (P＜0.01). Multivariate Logistic regression analysis showed that alcohol consumption, high body mass index and Pittsburgh sleep quality index score were independent risk factors for the occurrence of NH. Conclusion The proportion of NH is high in young and middle-aged hypertensive patients, and the drop magnitude of nocturnal blood pressure in NH patients is smaller. Abstinence from drinking, losing weight and improving sleep quality are important means to control NH.