Treatment of hypertension has decreased the incidence of stroke and congestive heart failure consequential to hypertension. To determine whether the incidence of hypertension as a causative diagnosis of end-stage renal disease (ESRD) is also decreasing, we examined the records of the Health Care Financing Administration (HCFA) from 1980 to 1986 regarding the causative diagnoses of patients entering ESRD programs. We found that the incidence of patients entering ESRD programs increased during the study period. Hypertension as a causative diagnosis was a constant proportion of the increase. The greatest increase occurred in patients age 55 or more years. This was strikingly true of black patients. We conclude that there has not been a decrease in the incidence of hypertension as a causative diagnosis for patients entering ESRD programs and that this may be a reflection that treatment of hypertension does not prevent the development of ESRD in some patients. We propose that prospective studies be undertaken to determine whether this is the case.