In the aim to determine the importance of renal disease in hypertensives (BP > 160/95 mmHg), we conducted a retrospective study in Burkina Faso, a black african country. 342 adults hypertensive (200 men, 142 women, mean age: 50.6 +/- 13.8 years) hospitalized in the departments of Cardiology or Internal medicine from January 1995 to December 1997 were included. Patients were at their first hospital stay in 273 cases (79.8%). When technical conditions were available, assessments were systematically done. Blood pressure was 183.6 +/- 36.4/113.3 +/- 23.1 mmHg. Total morbidity concerned 316 patients (92.4%). Cardiovascular complications (CVC) have been diagnosed in 236 patients (69%) with a mean age of 51.6 +/- 14 y, neurologic complications (NC) in 85 patients (24.9%, mean age: 55.7 +/- 12) and renal disease (RD) in 123 patients (36%; mean age: 44.7 +/- 14.5 y). Mean age of single RD (n: 27, mean age: 39.5 +/- 12.8 y) was significantly lower than no complicated hypertensives (n: 42, mean age: 48.2 +/- 11.6 y) or single CVC (n: 104, mean age: 55 +/- 12.5) or single NC (n: 34, mean age: 55.1 +/- 11.1) or associated comorbidities (n: 135, mean age: 49.1 +/- 14.5). Patients under 40 years of age have had higher 24 hours proteinuria than other patients (1.05 +/- 1.17 g (n: 51) vs 0.45 +/- 0.68 (n: 170), p < 0.01). Chronic renal failure occurred in youngest patients (n: 72, age: 39.7 +/- 13.4 vs 53.7 +/- 12.3; p < 0.01) with a most high prevalence in rural (31.6%) than urban patients (15.8%; p < 0.01). End stage renal failure concerned 49 patients (mean age: 35.9 +/- 12.7). 27 patients died during hospital stay by renal failure in 17 cases (mean age: 37 +/- 11). CVC in 5 cases (mean age: 68.6 +/- 8) and NC in 5 cases (mean age: 60.2 +/- 9.2). Among survivals, 72 patients (28.9%) were of a bad short-term prognosis and 38 had end stage renal failure. In conclusion, our data suggest that renal disease will be common cause of hypertension and also a selective factor for long term survival of hypertensives in a country where renal replacement therapy is not available.