As we all know, the incidence of hypertension in our population is continuously increasing, and almost 1/3 of the adult population in China has high blood pressure or blood pressure above the normal high value. This means that the number of people with hypertension in China is large, with some statistics approaching or possibly even exceeding 300 million. Long-term hypertension can lead to abnormal changes in the structure and function of the renal artery vessels, which in turn can lead to structural and functional lesions of the kidney and eventually renal insufficiency or even renal failure. What should be noted in the treatment process for patients with hypertension combined with renal insufficiency? The following will be combined with the latest hypertension guidelines in China to make a detailed introduction. First, the relationship between hypertension and kidney disease The human urinary system is like a “wastewater excretion system”, which plays an important role in maintaining the physiological balance in the body. The kidney is an important organ in the urinary system, and its main function is to excrete the body’s metabolites outside the body to maintain the balance of the internal environment. Hypertension and chronic kidney disease are causative of each other and interact through multiple pathways. Hypertension is both a cause and a key factor in the progression of chronic kidney disease; chronic kidney disease is associated with a high incidence of hypertension and a low rate of control, with a great risk of cardiovascular disease and death. Rational antihypertensive treatment can delay the progression of chronic kidney disease, prevent organ damage and reduce the risk of cardiovascular events in patients with chronic kidney disease. Second, the antihypertensive target of hypertension combined with renal disease According to the latest guidelines for the prevention and treatment of hypertension in China: chronic kidney disease combined with hypertension patients with systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg start drug antihypertensive treatment. The target of antihypertensive therapy is <140/90 mmHg when albuminuria is <30 mg/d and <130/80 mmHg when 30-300 mg/d or higher. the target of antihypertensive therapy can be relaxed in patients over 60 years old. The choice of antihypertensive drugs for patients with hypertension combined with renal disease In addition to the generally applicable antihypertensive efficacy, safety and compliance, the choice of antihypertensive drugs for patients with chronic kidney disease also requires comprehensive consideration of whether the patient has combined diabetes and proteinuria, cardioprotective effects, and drug selection considerations for special populations such as hemodialysis, renal transplantation, children and elderly patients with chronic kidney disease. The main drugs available are ACEI (priligy), ARB (sartan), CCB (diphenhydramine), thiazide diuretics, and beta-blockers. Initial treatment should include an ACEI/ARB, alone or in combination with other antihypertensive drugs, but the combination of both is not recommended. If the increase of blood creatinine is less than 30% compared with the basal value after medication, it can still be used cautiously, and if it exceeds 30%, it can be considered to reduce or stop the medication. If the increase of blood creatinine is less than 30% compared with the base value, it can still be used with caution, and if it exceeds 30%, it can be considered to reduce or stop the drug. Both dihydropyridines and non-dihydropyridines CCBs can be used, and the renoprotective effect depends on their hypotensive effect; for GFR >30ml/min-1.73m2 (CKD stage 1 to 3), thiazide diuretics are effective; for <30ml/min-1.73m2 (CKD stage 4 to 5), tab diuretics are available. For end-stage renal disease dialysis patients, some patients exhibit refractory hypertension, requiring a combination of multiple drugs. Instead of ACEI or ARB and thiazide diuretics, antihypertensive therapy with CCB and tab diuretics is generally available, with the addition of alpha/beta blockers when necessary. The use of RAS inhibitors in hemodialysis patients should be monitored for potassium and creatinine levels. The dose of antihypertensive drugs needs to be adjusted considering the hemodynamic changes and the clearance of drugs by dialysis. It is important to avoid the use of antihypertensive drugs during the phase of sudden reduction of dialysis blood volume to avoid severe hypotension. The variability of blood pressure in dialysis patients is not easy to be too large. The ideal target for systolic blood pressure after dialysis is 120 to 140 mmHg.