Renal sodium handling is known as an important function that maintains both body fluid volume and blood pressure regulation. Recently, advances in molecular biology have led that alterations of tubular sodium handling are closely related to changes of blood pressure. Also, tubular sodium uptakes are controlled by any protein participating in its reabsorption and regulation, which are influenced by genetic, nutritional, metabolic and neurohormonal factors. All of these factors, alone or combination, may be able to impair the normal renal tubular sodium handling and develop high blood pressure. The investigations about the role of kidney in hypertension are shifting toward inherited as well as acquired tubular defects and further studies about renal sodium handling based on sodium transporters on the tubular segments will be needed. This review will discuss the relationship between renal sodium handling and hypertension.