Hypertension is an enormous public health burden, affecting an estimated 1 in 3 adults in the United States1 and often cited as the second leading cause of kidney failure.1 African Americans are at particularly high risk for both hypertension and kidney failure, and the relation between hypertension and kidney failure is thought to be stronger in African Americans than whites.2 However, most of these cases of kidney failure are not histologically confirmed, and there remains controversy as to how much of a causal role elevated blood pressure (BP) plays in promoting chronic kidney disease (CKD) and kidney failure overall, as well as in different races.