Despite common wisdom, the role of essential hypertension in the etiopathogenesis of ESRD has been controversial. Two recently published studies demonstrated a strong association of genetic variants in the gene that encodes the molecular motor protein nonmuscle myosin 2a (MYH9) with ESRD in African American patients without diabetes. These new data demonstrate that much of the excess risk of ESRD in African American individuals is attributable to an MYH9 risk haplotype and suggest that hypertension may cause progressive kidney disease only in genetically susceptible individuals or be the result of a primary renal disease.