Hypertension has become the most important risk factor for cardiovascular events and cardiovascular death worldwide, with a high prevalence, extensive damage to organs, and significant risk weight compared with other risk factors. Globally, the incidence of chronic kidney disease (CKD), including end-stage renal disease (ESRD), is showing a significant increase, with a prevalence of about 10% in adults. The main causative factors include hypertension, diabetes, renal atherosclerosis, and chronic heart failure, of which hypertension is most closely associated with chronic kidney disease (CKD). Therefore, screening for and intervening in the development and progression of chronic kidney disease (CKD) in the early stages of hypertension has become an important initiative for target organ protection in hypertension. This article briefly introduces the progress of hypertension and chronic kidney disease (CKD) research. The Department of Geriatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Hongliang Liu I. Chronic kidney disease (CKD) is an important independent predictor of cardiovascular events and death Chronic kidney disease (CKD) is defined as a chronic impairment of renal structure and function, as evidenced by an estimated glomerular filtration rate (eGFR) and/or the presence of markers of renal damage, including proteinuria, non-surgical hematuria, tubular or pathologic changes. Large clinical cohort studies have affirmed the independence of chronic kidney disease (CKD) from traditional assessment systems such as Framingham in predicting cardiovascular prognosis and death. Urinary albumin in the setting of diabetes is a sensitive risk factor for cardiovascular events, and progression of nephropathy. In contrast, in non-diabetic hypertensive patients, microalbuminuria has become increasingly accepted as a predictor of long-term cardiac and renal prognosis – cardiovascular events, chronic renal insufficiency, ESRD. 917 non-diabetic hypertensive patients were enrolled in the MAGIC study with 11.8 years of follow-up, and the latest results showed that basal level urinary Albumin-creatinine excretion rate (ACR) was an independent risk factor for the development of associated chronic renal insufficiency and cardiorenal composite endpoints, and microalbuminuria remained strongly associated with chronic renal insufficiency and cardiorenal events even after controlling for other risk factors at baseline levels, including age, BMI, blood pressure, cholesterol, and renal function indicators. Large sample studies of eGFR, ACR and urine protein quantification have shown that eGFR <60 ml・min-1・(1.73m2)-1 is strongly associated with cardiovascular mortality and all-cause death, and ACR and early morning proteinuria are also associated with cardiovascular disease progression and all-cause death. In addition, proteinuria has predictive value for all-cause death, myocardial infarction and ESRD at different eGFR levels, and in some populations, severe proteinuria has even better predictive value than eGFR. It is evident that proteinuria is an integrated marker of multiple risks for poor cardiac and renal prognosis, regardless of the degree of glomerular damage. When eGFR was 80 ml min-1 (1.73 m2)-1 (chronic kidney disease (CKD) stage 2) and proteinuria (++++), the risk of death was eGFR 50 ml min-1 (1.73 m2)-1 (chronic kidney disease (CKD) stage 2). (chronic kidney disease (CKD) stage 3) and proteinuria-negative patients was twice as high. This shows that in non-diabetic hypertensive patients, microalbuminuria reflects vascular structural functional impairment, accompanied by coronary artery calcification and atherosclerotic progression, and can independently predict poor cardiovascular and renal prognosis. Therefore, the application of microalbuminuria testing should be promoted to guide hypertension treatment. Second, insufficient screening for chronic kidney disease (CKD) in hypertension and missed diagnosis Chronic kidney disease (CKD) in combination with hypertension gradually progresses to ESRD on the one hand, imposing a huge economic burden on patients and society; on the other hand, the risk of various cardiovascular events, including cardiovascular death, increases several-fold to ten-fold in hypertension in combination with chronic kidney disease (CKD), and a significant proportion of chronic kidney disease (CKD) patients change the course with cardiovascular events and death at all stages of the disease. Thus, hypertension combined with CKD has become a serious public health and safety issue. In the US National Health and Nutrition Examination (1999-2006), the prevalence of chronic kidney disease (CKD) among 5832 hypertensive patients was 13.4%, 22.0%, and 27.5% in normotensive, prehypertensive, and hypertensive patients, respectively. However, globally, hypertension and prehypertension have a large amount of chronic kidney disease (CKD) that is overlooked by clinicians, and clinically undiagnosed and untreated chronic kidney disease (CKD) is widespread in all countries around the world. The low awareness of CKD exists not only among patients but also among physicians in multiple specialties of internal medicine. Physicians lack knowledge of the risk factors and pathogenesis of CKD, and lack screening, diagnosis and intervention for CKD in at-risk populations. As a result, patients' knowledge and awareness of chronic kidney disease (CKD) is even more lacking. According to one study, among patients with CKD with eGFR <60 ml/min-1/(1.73 m2)-1 and positive proteinuria, the awareness rate of patients with CKD stage 3 was only 7.5%, and that of patients with CKD stage 4 was less than 50%. Even if they know they are hypertensive or diabetic and have reached stage 3 to 4 chronic kidney disease (CKD), the awareness rate of patients is less than 20%. Although the role of diabetes in the development of chronic kidney disease (CKD) has been recognized, the pathogenic role of hypertension in chronic kidney disease (CKD) is often overlooked or underestimated. On the one hand, because sensitive and reliable methods for evaluating renal damage - eGFR and urinary microalbumin excretion rate tests - have not been given due attention and promoted, many patients are not detected until chronic kidney disease (CKD) has progressed to the mid- to late-stage, or even the ESRD stage; on the other hand, physicians are not interested in hypertension combined with On the other hand, physicians' awareness of hypertension combined with chronic kidney disease (CKD) is far from adequate, and in the diagnostic procedures of most hospitals in China for non-nephrology specialties, the number of patients with CKD as a diagnostic term is minimal, resulting in a large number of hypertensive patients, even though they have proteinuria and decreased eGFR, but there is no corresponding clinical diagnosis and lack of targeted interventions. Chronic kidney disease (CKD) due to hypertension is not solely the result of renal hemodynamic abnormalities in hypertension; the abnormally activated neuroendocrine system, oxidative stress, and endothelial functional impairment in the pathogenesis of hypertension are all involved in the renal damage caused by hypertension. In addition, other cardiovascular metabolic risk factors that are closely associated with hypertension and are parallel and causal to each other, such as diabetes mellitus, dyslipidemia, hyperuricemia, and ischemic nephropathy on the basis of renal atherosclerosis, are also common causative factors of hypertension-related renal damage. Currently, eGFR and proteinuria/microalbuminuria tests have been used in clinical practice to evaluate kidney damage and diagnose chronic kidney disease (CKD). eGFR is much more accurate and refined than plasma creatinine level to show glomerular filtration damage, and urine microalbumin can reflect early glomerular vascular basement membrane damage. The target blood pressure control level in hypertension combined with chronic kidney disease (CKD) is recommended by JNCVII (2003), K/DOQI (2004), and the European Guidelines on Hypertension (2007) to be <130/80 mmHg. The MDRD study with 6-year follow-up showed a reduced risk of renal failure in the group with the lowest blood pressure target value.The MDRD and AASK studies found that low blood pressure target values benefited hypertensive patients with urinary protein >1000 mg/d or ACR >0.22.In the AASK study, the ACR >0.22 subgroup, equivalent to 300 mg of proteinuria per day, was controlled with RAS inhibitors < 130/80 mmHg,8.8 to 12.2 years of follow-up, reduced the risk of multiple endpoints including creatinine multiplication, ESRD, and death. A meta-analysis included 3 clinical studies and 2272 patients with non-diabetic chronic kidney disease (CKD), including a proteinuric subgroup, with a blood pressure target set at <(125-130)/(75-80) mmHg, with no further improvement in endpoint events at 2 to 4 years of follow-up. The recent REIN-2 study also showed that strict blood pressure control failed to benefit patients with chronic kidney disease (CKD) even when urine protein was positive. Currently, there is no evidence of benefit for protein-negative chronic kidney disease (CKD) with blood pressure reduction to <130/80 mmHg; there is no direct evidence of benefit in elderly patients over 70 years of age with hypertension combined with chronic kidney disease (CKD) with a target blood pressure of <130/80 mmHg, and most clinical studies have not enrolled these patients; and there is a lack of studies of target blood pressure in systolic hypertension alone combined with chronic kidney disease (CKD). There is a lack of studies on target blood pressure in patients with simple systolic hypertension combined with chronic kidney disease (CKD). Most authors agree that there is insufficient evidence to suggest a further benefit of lowering blood pressure to <130/80 mmHg in all patients with chronic kidney disease (CKD). The lower the blood pressure target value, the greater the variety of antihypertensive drugs required, the increased risk of drug-drug interactions and adverse effects, and the need for close monitoring and protection against hypotension. Elderly patients with hypertension combined with chronic kidney disease (CKD) and many combined cardiovascular risk factors should implement individualized treatment regimens, especially when proteinuria is negative, and blood pressure should not be controlled too low. Most scholars agree on the following protocols: hypertension combined with diabetic chronic kidney disease (CKD), non-diabetic chronic kidney disease (CKD)-proteinuria positive, target blood pressure should be <130/80 mmHg; non-diabetic chronic kidney disease (CKD)-proteinuria negative, target blood pressure should be <140/90 mmHg. IV. Current problems and doubts In hypertension combined with chronic kidney disease (CKD) There are still many questions that need to be clarified and verified in the diagnosis and treatment of hypertension combined with chronic kidney disease (CKD), such as: Is there an exact parallel between proteinuria and reduced glomerular filtration rate? Is there a separate, superimposed and complementary relationship between the two in terms of reflecting renal damage? Does the accuracy and calculation method of eGFR, a common indicator of glomerular filtration rate, need to be standardized? Can RAS system inhibitors improve the course of renal damage in non-diabetic hypertensive patients with negative proteinuria? In particular, the target blood pressure level for antihypertensive therapy in hypertension combined with chronic kidney disease (CKD) remains to be studied and redefined in depth.