Hypertension is very common in dialysis patients. The most important cause of hypertension is hypervolemia. Fluid restriction and volume management with standard hemodialysis are effective strategies to achieve dry weight and blood pressure control without use of antihypertensive drugs. If the captopril test is positive, a renin-angiotensin system blocker should be started. The pre-dialysis blood pressure goal in hemodialysis patients should be < 140/90 mm Hg initially and < 130/80 mm Hg at 3-6 months of dialysis.