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To describe patterns of hypertension history in patients with various types of end-stage renal disease (ESRD) and in persons with normal kidney function; and to identify risk factors for the diagnosis ‘hypertensive ESRD’.A case–control study.Population-based.Patients with ESRD due to hypertension (n = 214), diabetes (n = 239), other specified causes (n = 181), unknown causes (n = 82) and control subjects drawn from the general population (n = 361).Participants' history of hypertension.The prevalence of hypertension was 90% in ESRD patients and 27% in controls. Only 6% of patients with hypertensive ESRD had a history of malignant hypertension. Patients with hypertensive ESRD were more likely to have been hospitalized because of hypertension (36%) than were other ESRD patients (18%) or controls (5%). ESRD of any cause was more strongly associated with hypertension of ≥ 25 years duration (odds ratio 51.0, compared with normal blood pressure) than it was with hypertension of shorter duration (15–25 years: odds ratio 31.8, 5–15 years: odds ratio 16.0, <5 years: odds ratio 21.2). Among patients who had both hypertension and ESRD, the diagnosis of ‘hypertensive ESRD’ was associated independently with a long duration of hypertension, greater severity of hypertension, the absence of diabetes, black race, and limited education.Hypertension is common among patients with ESRD. The risk of ESRD from any cause increases progressively with the duration of hypertension, and with indicators of severe hypertension. This result supports the hypothesis that nonmalignant hypertension of long duration may cause renal insufficiency. The criteria used to diagnose hypertensive ESRD are consistent with pathophysiologic and epidemiologic evidence.