Hypertension in ADPKD might start at an early age and is driven by a complex interplay of polycystin (PC) dysfunction, intracellular signaling disruptions, and activation of the renin-angiotensin-aldosterone system (RAAS), which can contribute to vascular structural changes and impaired endothelial function. The gene discussed is REN; the disease is autosomal dominant polycystic kidney disease.