Hypertension is one of the main risk factors for cardiovascular diseases. In this study we aimed to evaluate efficiency and safety of carvedilol treatment in refractory hypertensive patients with renal diseases, including chronic kidney disease (CKD), polycystic kidney disease (PKD), dialysis and post-transplantation population. A multicentre, prospective, open label, self-compared trial was conducted in the east area of China in 2005. Two hundred and seventeen patients were enrolled in this study. Mean arterial blood pressure (systolic/diastolic) at 4weeks significantly reduced in comparison with that before the use of carvedilol (142.6±14.4/84.2±10.1mmHg vs 166.2±18.1/90.4±11.0mmHg, P<0.05), and then it continued to drop to 136.9±12.4mmHg/80.1±10.6mmHg at the completion of trial (week 8). Total efficiency (subjects with a BP less or equal to 130/80mmHg or having a fall of greater or equal to 10mmHg in DBP or greater or equal to 30mmHg in systolic blood pressure) was 57.1% at 4weeks and 79.7% at 8weeks, and dominant efficiency (subjects with a BP of less or equal to 130/80mmHg and those showing a fall of greater or equal to 10mmHg in diastolic blood pressure) was 11.5% and 26.7%, respectively. Mean heart rate declined from 79.3±10.2/min to 75.9±7.6/min at 4weeks and 75.0±8.5/min at 8weeks (P<0.05). Plasma norepinephrine level decreased from 38.7pg/mL before this trial to 17.6pg/mL (P<0.05). The total number of patients experiencing at least one adverse event was 13. None resulted in withdrawal of the patient from study. This study suggests that carvedilol is an efficient and safe drug in treatment of refractory hypertensive patients with renal diseases.