Hypertensive kidney disease is defined as the damage to the kidney resulted from chronic high blood pressure (BP), which is pathologically classified as benign and malignant arteriolar nephrosclerosis. Given the increasing morbidity and mortality in patients with hypertensive kidney disease, therapeutic strategies for controlling BP and maximal reducing albuminuria are needed for delaying the progression of hypertensive nephropathy to end-stage renal disease. Most individuals with hypertensive kidney disease require combined use of three or more antihypertensive medications. Weight loss, exercise, and restriction on salt and alcohol intake may aid in BP control. The early recognition and adoption of potent approach to evaluate and manage patients with resistant hypertension may be effective strategies to achieve the BP targets. The malignant hypertension is life-threatening and requires immediate BP reduction for preventing irreversible target organ damage.