GENETIC DISEASE MODELS: A certain proportion of hypertension cases are due to renal disease. Recent advances in genetics has improved our knowledge of the pathophysiological mechanisms involved in certain rare diseases including apparent overproduction of mineralocorticoids, Liddle syndrome and Gitelman syndrome, and to hypothesize on the mechanism of primary hypertension. EFFECT ON PROGNOSIS: Onset of renal disease in hypertensive patients, whether expressed by proteinuria or the early stages of renal failure, worsens cardiovascular prognosis. FREQUENCY OF RENAL DISEASE: Renal disease is relatively rare in hypertensive patients, but as the general hypertensive population becomes older, there is a considerable rise in the prevalence of hypertensive renal disease as the underlying cause leading to dialysis. The risk of progressing to renal failure appears to be related to the level of the blood pressure, especially systolic pressure, at disease onset. Hypertension black subjects have a higher risk of developing chronic renal failure. THERAPEUTIC BENEFIT: Several studies have shown that lowering blood pressure with antihypertensive drugs lowers the risk progressing with primary hypertension.