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Introduction According to the 2023 World Health Organization (WHO) estimates, 1.28 billion adults between 30 and 79 years old suffer from hypertension and about 1 in 5 have it under control ( Blood pressure (BP) regulation is extremely complex, and several endocrine, nervous, vascular and immune factors are closely interconnected in hypertension pathogenesis ( Arginin-vasopressin (AVP), also known as antidiuretic hormone (ADH), is a 9-amino-acid peptide synthetized by the magnocellular neurons located in the supraoptic and paraventricular nuclei of hypothalamus and secreted in response to raised serum tonicity and/or reduced effective circulating arterial blood volume ( in vitro , its vasoconstrictor effect, mediated by V1a receptors on smooth muscle cells, has shown to be greater than that of angiotensin II ( In vivo , however, its importance is presumably limited by the activation of counter-regulatory mechanisms, including the baroreceptor reflex and the modulation of cardiac output by AVP itself ( Interestingly, in 1958, Ginetzinsky demonstrated that hyaluronic acid (HA) metabolism in the renal interstitium is closely related to water handling and AVP action ( As hyaluronidase excretion in the urine has been shown to be inversely correlated to body water balance ( Materials and methods Study population Recruitment of study population took place between 2005 and 2008 as part of the I Demand (Italy Developing Education and awareness on Micro-Albuminuria in patients with hypertensive Disease) Project, a multicenter observational study promoted by the Italian Society of Hypertension