The development and progress of renal deterioration in patients with essential hypertension administered antihypertensive therapy remain unclear. In this retrospective analysis, we divided 25 essential hypertension patients who eventually required hemodialysis (HD) from 1981 to 1990, into those with malignant essential hypertension (MEH) (N = 9) and those with benign essential hypertension (BEH) (N = 16), and analyzed the clinical features, the rate of renal deterioration, and outcome in each group. The patients with MEH were significantly younger, and had a shorter duration of hypertension than those with BEH. There were no significant differences between the two groups in urinary volume, cardiothoracic ratio, hematological findings or blood chemistry at the initiation of HD. However, blood pressure in the patients with MEH was significantly higher than that in the patients with BEH at that time despite antihypertensive treatment. There was also no significant difference between the groups in the slope of reciprocal creatinine. The latter was significantly correlated with the level of blood pressure and serum total cholesterol. Considering the outcome, all of the patients with MEH survived for 5 years. These results suggest that the more rapid progression of renal deterioration in the patients with essential hypertension might be related to the severity of hypertension and to lipid abnormalities during antihypertensive therapy.