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Hypertension is a frequent complication of reflux nephropathy. The cause of this hypertension is unknown. Our study was undertaken to assess the possible role of the renin-angiotensin system in the hypertension associated with unilateral reflux nephropathy. We selected for study 17 normotensive and 12 hypertensive patients with strictly unilateral reflux nephropathy. There were 3 normotensive and 2 hypertensive patients with a renal vein renin ratio exceeding 1.5. Of these 3 normotensive patients 1 had evidence from divided renal function studies to suggest functional renal ischemia. No consistent evidence was obtained to support the concept that the renin-angiotensin system has a primary role in the non-malignant hypertension of unilateral reflux nephropathy.