Background <p>Metabolic syndrome (MS) is a well-established risk factor for chronic kidney disease (CKD), especially in hypertensive patients. These patients are more likely to exhibit additional components of MS, further elevating their risk of developing CKD. This study aimed to investigate the association between the components of MS and the risk of CKD in hypertensive patients.</p> Methods <p>This retrospective cohort study included 51,470 hypertensive patients who participated in the national basic public health services for hypertension management in Minhang District, Shanghai, China. Cases of CKD were identified through linkage with elderly physical examination statistics. Multivariable-adjusted Cox proportional hazard models were used to assess the relationship between the number of MS components and the risk of CKD. Additionally, the study explored the associations between different combinations of MS components and CKD.</p> Results <p>During the 3-year follow-up period, the incidence of CKD was significantly higher in hypertensive patients with MS compared to those without MS (33.77 vs. 25.67 per 1000 person-years). Hypertensive patients with MS had a 15% increased risk of developing CKD compared to those without MS. Furthermore, the risk of CKD increased progressively with the number of MS components (<i>P</i> for trend &lt; 0.01; HR 1.17, 1.27, and 1.37 for 3, 4, and 5 components, respectively, versus 1 component). Additionally, elevated waist circumference (WC) was significantly associated with CKD in hypertensive patients with only one additional MS component (<i>P</i> &lt; 0.05).</p> Conclusion <p>In hypertensive patients, the risk of CKD significantly increases with the accumulation of MS components. Notably, elevated WC in hypertensive patients is particularly associated with a higher risk of CKD.</p>