In the past 20 years, clinicians have clearly demonstrated that antihypertensive therapy is very effective in reducing the incidence of myocardial infarction and stroke. However, little is known about the effects of blood pressure reduction on end stage renal disease (ESRD). Data from major clinical studies has clearly shown that patients with hypertension have an increased risk of developing ESRD. Black men and women with hypertension are at the greatest risk; however, the incidence of ESRD is increasing in all racial groups. Because patients with hypertensive ESRD often require dialysis, the cost of treating this increasing common disorder has the potential to deplete the Medicare system. The primary effect of blood pressure reduction in patients with ESRD has not been adequately addressed in any trial that has been completed to date. Results from some studies suggest that blood pressure reduction may improve renal function and that angiotensin converting enzyme inhibitors and calcium channel blockers may have renoprotective effects. Currently in progress are two large scale clinical trials that may provide more information on the effects on antihypertensive therapy on preventing ESRD in hypertensive patients. These are the African American Study of Kidney Disease and Hypertension (AASK), and a substudy of the Hypertension Optimal Treatment (HOT) Study. Data from the HOT study is expected to be available 5 years prior to that of the ASK Study, which is expected to be completed by the Year 2002.