The height of blood pressure and the degree of renal pathology are closely related. The final pathological change of primary hypertension in the kidney is renal arteriosclerosis, hypertension can be the cause of chronic kidney disease, and renal pathology can also be the cause of the increase of blood pressure, and they are mutually beneficial. In fact, all patients with uncontrolled hypertension have renal lesions, but in the early stages there can be no clinical manifestations. During the course of mild to moderate essential hypertension, it may not be accompanied by structural and functional changes in the kidneys, but may be accompanied by a decrease in the function of the apoptotic nodes. As the disease progresses, proteinuria may appear, and control of hypertension may reduce urinary protein. If the disease progresses steadily, mild to moderate renal arteriosclerosis may develop after 5-10 years. In about 7% of patients with essential hypertension, there may be a sudden and progressive increase in blood pressure during the course of the disease, with rapid development of renal changes, mostly accompanied by progressive renal hypoperfusion and even renal failure, and eventually uremia. However, in slowly progressive hypertension, most patients die of cardiovascular and cerebrovascular complications before developing uremia. Effective antihypertensive therapy can reduce cardiac hypertrophy and systemic small artery damage, but whether it can slow down the onset and development of renal small artery sclerosis remains to be confirmed by further studies.