Hypertension and renal parenchymal disease are intricately linked. Primary renal parenchymal disease can impact on sodium and volume regulation and lead to hypertension, while arterial hypertension can induce renal parenchymal injury and precipitate renal dysfunction. The examination for clues to the environmental origins of renal disease and hypertension necessitates an approach that integrates epidemiology, clinical medicine, developmental biology, environmental science and epigenetics, such that the manner in which genes and the environment interact can be better understood to pave the way for innovative management paradigms with regards to prevention, diagnosis and treatment. This review summarizes the extant literature and provides cogent arguments for the need to evaluate chronic adult onset disease models such as hypertension and renal disease from the modern perspective that takes into account prenatal exposures, the intrauterine environment and development, postnatal growth and transgenerational epigenetic modifications with their attendant future disease risk from the individual to the population level.