Hypertension is both the cause and effect of kidney disease. Together these two diseases have become epidemics in our society and are associated with an increased risk of cardiovascular events. Over the last several decades multiple clinical and transplant studies have shown the kidney to be an important determinant of essential hypertension. However, little is known about the direct mechanisms in which the kidney induces hypertension or why the blood pressure tends to rise in the failing kidney. This document provides a systematic analysis of peer-reviewed, published literature pertaining to the central role of the kidney in the development of essential hypertension in adults. We will describe the pathophysiology of essential hypertension and its relationship to chronic kidney disease and cardiovascular disease. Particular focus will be drawn to effects of sodium handling, the renin angiotensin aldosterone system, the sympathetic system and mediators of vascular tone in the development of kidney induced hypertension. In addition, the mediators which initiate and maintain the progression of chronic kidney disease, and how these factors are related in the development of hypertension will also be discussed. Finally, therapeutic strategies to treat individuals with chronic kidney disease in order to prevent the development of essential hypertension and lower their cardiovascular risk will be presented.