A survey was conducted among 152 adult male paraplegic and quadriplegic patients known to have chronic urinary tract infection. Many had x-ray film evidence of renal involvement, but few had elevated serum creatinine levels. Elevated blood pressure was rare in these patients. Review of the literature confirms this finding, but emphasizes the major role of hypertension and pyelonephritis in those who die as a result of the spinal cord injury. It would appear that hypertension is a late manifestation of severe pyelonephritis and amyloidosis. These results may explain why it has been difficult to clearly associate bacteriuria (which is very common in the general population) with hypertension, but relatively easy to detect bacteriuria among hypertensive patients. Prevention of hypertension remains an important goal for patients with recurrent or persistent urinary tract infections.