Although we have seen a decreased incidence of some of the complications of hypertension, such as myocardial infarction and stroke, the same cannot be said for end-stage renal disease (ESRD). The disparity brings up the question of why improvements in hypertension control apparently do not bring improvement in the incidence of ESRD. Some of the factors likely at play include variation in the mechanisms at work in hypertensive patients of different races and variation in the degree to which antihypertensive agents affect systemic blood pressure and glomerular capillary pressure. These and other factors relating to hypertension and ESRD are the focus of this review.