Objective: To assess the use of antihypertensive drugs and blood pressure (BP) levels in relation to current guidelines for BP control in patients with chronic renal failure (CRF). Material and Methods: A cross-sectional survey was carried out in six renal outpatient clinics in Oslo and the surrounding area. The hospital records of all renal patients not yet in need of renal replacement therapy and with serum creatinine > 200 µmol/L who attended consultations with nephrologists regularly (at least every 3rd month) were reviewed. Results: Of the 351 patients, 97% had hypertension. The majority of patients (96%) were receiving antihypertensive therapy. The average number of antihypertensive drugs was 2.7 +/- 1.3 (median 3), but it varied with the cause of CRF. The drugs most frequently prescribed as monotherapy were angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, which were used by 32%; 51% of patients were using three or more antihypertensive drugs. Loop diuretics were prescribed as monotherapy in 25% of cases and in combination with two or more other drugs in 87%. Age and serum creatinine levels influenced the choice of antihypertensive therapy. The target BP of < 130/80 mmHg was obtained in 13% of patients, and lack of optimal BP control was mainly due to systolic hypertension. A total of 38% of patients had a BP of < 140/90 mmHg, while 58% failed to achieve a systolic BP of < 140 mmHg.Conclusion: Optimal blood pressure control is hard to achieve in patients with CRF, even with specialist care and the use of multiple antihypertensive drugs.