Hypertension is one of the most important independent risk factors for end-stage kidney disease (ESKD), along with diabetes mellitus.1,2 However, previous studies regarding the association between high blood pressure (BP) and ESKD have been limited by the fact that BP was measured at baseline or a single time-point which does not represent the consistent status of hypertension.2,3 As BP changes over time, cumulative high BP has emerged as a marker of interest to provide an integrated assessment of the long-term severity of BP and duration of exposure to high BP.4 In prospective cohort studies, cumulative episodes of high systolic and diastolic BP in young adults were associated with cardiovascular diseases or higher urine albuminuria later in life.4,5 Furthermore, a recent study also demonstrated that visit-to-visit variability in systolic or diastolic BP was independently associated with the development of ESKD.6 However, the calculation of cumulative BP and BP variability, including the standard deviation, coefficient of variation, and variability independent of the mean, is quite complex and, therefore, not easy to apply in clinical practice. In this context, there is a paucity of data regarding the association between the cumulative hypertension burden over a certain period and the risk of ESKD. Additionally, it is unclear whether an increased systolic or diastolic hypertension burden, respectively, is associated with the risk of ESKD. Therefore, this lecture will provide information about the association between the exposure to hypertension over consecutive years and the risk of ESKD in patients selected from a nationwide cohort.7 In addition, we can deeply discuss cumulative hypertension burden and kidney outcomes.   Reference 1.         Leiba A, Fishman B, Twig G, Gilad D, Derazne E, Shamiss A, et al. Association of Adolescent Hypertension With Future End-stage Renal Disease. JAMA Intern Med. 2019;179(4):517-523. 2.         Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med. 2005;165(8):923-928. 3.         Bell EK, Gao L, Judd S, Glasser SP, McClellan W, Gutierrez OM, et al. Blood pressure indexes and end-stage renal disease risk in adults with chronic kidney disease. Am J Hypertens. 2012;25(7):789-796. 4.         Nwabuo CC, Appiah D, Moreira HT, Vasconcellos HD, Yano Y, Reis JP, et al. Long-term cumulative blood pressure in young adults and incident heart failure, coronary heart disease, stroke, and cardiovascular disease: The CARDIA study. Eur J Prev Cardiol. 2020;doi:10.1177/2047487320915342):2047487320915342. 5.         Kramer H, Colangelo L, Lewis CE, Jacobs DR, Jr., Pletcher M, Bibbins-Domingo K, et al. Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife. Am J Hypertens. 2017;30(5):502-509. 6.         Bae EH, Lim SY, Han KD, Oh TR, Choi HS, Kim CS, et al. Association Between Systolic and Diastolic Blood Pressure Variability and the Risk of End-Stage Renal Disease. Hypertension. 2019;74(4):880-887. 7.          Kim CS, Kim B, Choi HS, Bae EH, Ma SK, Han KD, Kim SW. Cumulative hypertension burden and risk of end-stage renal disease. Hypertens Res. 2021;44(12):1652-1661.