Acute kidney injury (AKI) is a heterogenic state that accompanies 20% emergency hospital admissions. Many of acute conditions are not associated with elevated blood pressure (BP). There are scarce data on arterial hypertension (AH) treatment and/or BP goals in AKI. AKI is independently associated with an increased risk of AH post-discharge. Hypertensive patients benefit from higher mean BP values. SPRINT trial post-hoc analysis detected attenuation in benefit of intensive BP reduction in linear correlation with descending estimated glomerular filtration rate (eGFR). Most AKI in the SPRINT trial were hemodynamic changes without structural changes. Systolic BP-fall beyond 25% in first 6h was independent predictor of AKI in hypertensive patients with acute heart failure. There is a gap in current guidelines regarding perioperative management of AH in high-risk population for developing AKI. There are concerns that renin-angiotensin-aldosteron system inhibitors (RAASi) can cause AKI in acute illness. However, the Angiotensin-converting enzyme inhibitors (ACEI) and Angiotensin II Receptor Blockers (ARB) were associated with a reduced incidence of postoperative AKI and reduced risk of progression to ESKD. On contrary, furosemide failed to reduce the risk of requiring dialysis and hospital mortality. While AH is a more common cause of AKI in surgical settings, hypotension can also be associated with AKI in sepsis and after surgery.