Introduction: To investigate the association between major dietary patterns and the incidence of chronic kidney disease (CKD) over a 3.6 year follow up in adults with high blood pressure. Materials and Methods: This cohort study was conducted on 1521 prehypertensive and hypertensive subjects, aged ≥ 27 years, without CKD at baseline, who participated in the fourth phase (2009-2012) of the Tehran Lipid and Glucose Study. Dietary data were collected using a valid food frequency questionnaire. Principal component analysis was performed to derive dietary patterns. Anthropometrics and biochemical measurements were obtained. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multiple Logistic regression analysis was used to examine the association between dietary patterns scores and risk of CKD. Results: The mean age of participants was 46.32±11.59 years. After 3.6 years of follow-up, 255 (16.8%) cases of CKD occurred. Three dietary patterns were identified, the western, healthy and the traditional Iranian patterns. After adjustment for relevant confounders, subjects in the highest, compared to the lowest quartile category of the Western dietary pattern score, had a higher risk of CKD (OR: 2.12; 95% CI: 1.19-3.76). Neither the healthy nor the traditional dietary patterns were significantly associated with incidence of CKD. Conclusions: Adherence to the Western dietary pattern is associated with increased risk of  CKD in adults with high blood pressure.