Although these findings do not eliminate the possibility that hypertension is a primary cause of renal disease, they do suggest that it could account for a smaller number of ESRD cases than currently estimated.

Numerous studies have shown that treating hypertension can slow the progression of chronic kidney disease. ACE inhibitors and ARBs exert an additional benefit by reducing proteinuria, which further retards progressive glomerulosclerosis and tubular injury.

Importantly, however, the African American Study of Kidney Disease and Hypertension Trial (AASK) demonstrated that in patients with hypertension and renal insufficiency, intensive blood pressure control (target MAP of 92 mm Hg) offers no additional benefit over standard control (target MAP of 102 to 107 mm Hg).