Hypertension is very prevalent and poorly controlled in patients on hemodialysis (HD), and is a major risk factor for the development of cardiovascular morbidity and mortality. The underlying mechanisms of hypertension in patients on HD are complex and multifactorial. Nurses need to be knowledge able about the underlying pathophysiology, blood pressure (BP) goals, and nonpharmacological and pharmacological interventions that can improve BP control during and in between HD sessions. This article summarizes the underlying pathophysiology of hypertension in patients on HD and reviews the literature about management of hypertension in patients with end stage renal disease.