Chronic kidney disease (CKD) and hypertension (HTN) have a complex, bidirectional relationship as declining kidney function increases blood pressure, while persistent hypertension worsens CKD. This cycle is well established in clinical and experimental research. In the Chronic Renal Insufficiency Cohort (CRIC) study of 3612 adults with CKD, 86 percent had hypertension compared to 29 percent in the general population. As CKD progresses, hypertension becomes more common and difficult to control.1 Intensive blood pressure lowering reduces kidney failure risk by 17 percent and end stage kidney disease by 18 percent, especially in those with proteinuria. 2 Management includes addressing renal pathology, setting blood pressure targets, and using lifestyle and medical therapies.