Background: Elevated blood pressure is an independent predictor of cardiovascular disease. Hypothesis: Hypertensive patients with apparently normal clinic blood pressure recordings can have abnormal Ambulatory Blood Pressure Monitoring (ABPM) profiles like nondipping and morning blood pressure surge. Abnormal ABPM profiles especially Morning blood pressure surge (MBPS) are associated with more severe hypertensive end organ damage and coronary artery disease. Methods: Fifty hypertensive patients with documented coronary artery disease and well controlled clinic blood pressure measurements who underwent successful ABPM recordings were included in the study. MBPS and dipping profiles were analyzed. The abnormal ABPM profiles were correlated with hypertensive end organ damage and coronary artery disease severity assessed by Gensini score. Results: 96% of the patients were nondippers. 62% of the patients showed morning blood pressure surge when calculated using sleep-trough morning surge. Patients with MBPS had higher LV mass and more hypertensive retinopathy. The severity and extent of coronary  artery disease by Gensini score was significantly higher in the MBPS group (59.74±31.35 vs 24.84±28.36) with a P value of 0.0002) Conclusion: A significant proportion of hypertensive patients with well controlled clinic blood pressure recordings have exaggerated MBPS and nondipping blood pressure profile identified by ABPM. MBPS is associated with more severe hypertensive target organ damage and coronary artery disease assessed by Gensini scoring system and is independent of the dipping status. In addition to anti-platelet medications, statins and lifestyle modifications, antihypertensive therapies targeting MBPS may help in preventing cardiovascular disease progression in hypertensive patients.