Hypertension is a major risk factor for chronic kidney disease (CKD), cardiovascular disease, cerebrovascular events, and premature death. However, certain groups are known to be at higher risk for hypertensive end-organ damage, including diabetic patients, older patients with isolated systolic hypertension, and specific ethnic populations. Coexistent diabetes and hypertension dramatically increase the risk of developing CKD and other target-organ complications. The prevalence of hypertension, left ventricular hypertrophy, CKD, hypertensive renal disease, and end-stage renal disease (ESRD) is far greater in African Americans compared with white Americans. Identification of patients at increased risk for CKD offers the potential to prevent or delay ESRD and the cardiovascular events associated with CKD. Data from completed and ongoing controlled clinical hypertension trials will assist clinicians in creating optimal antihypertensive regimens for patients at increased risk for CKD.