Hypertension has been reported as a possible sequela of extracorporeal shock wave lithotripsy (ESWL). To evaluate this issue as well as the risk of hypertension following other current non-ESWL treatment options for urolithiasis (percutaneous nephrostolithotomy [PCNL], combined PCNL and ESWL, ureteroscopy, and spontaneous stone passage), detailed blood pressure measurements were made in 961 patients at least 1 year after treatment. All follow-up blood pressures were measured with random-zero blood pressure devices. This study includes 731 patients who received ESWL only (with an unmodified lithotriptor), 171 patients treated with ureteroscopy or spontaneous stone passage (control subjects), 25 patients who received PCNL only, and 34 patients treated with both ESWL and PCNL. In patients who received ESWL only, the annualized incidence of hypertension (2.4%) did not differ significantly from that in control patients (4.0%). Among patients who received ESWL, no correlation was found between the incidence of hypertension and unilateral vs bilateral treatments, the number of shock waves administered, the kilovoltage applied, or the power (number of shock waves times kilovoltage). However, there was a significant rise in diastolic blood pressure after treatment with ESWL (0.78 mm Hg), but not in the control group (—0.88 mm Hg). The long-term significance of this change in diastolic blood pressure following ESWL is unknown and requires further study.