Kidney insufficiency is considered to represent a highly significant risk factor for cardiovascular disease, even when the glomerular filtration rate is only mildly reduced. Renal function has an influence on the prognosis that is independent of such conventional risk factors as hypertension and lipid metabolic disorders. Hypertensive patients suffering from renal insufficiency need particularly careful management to lower the cardiovascular risk in this special group of patients. Blood pressure targets in hypertensives with renal insufficiency are required to be lower than in patients with essential hypertension; current evidence points to a target of 125/75 mmHg.