Hypertension is both a fundamental etiological factor in the development of the disease and one of the most common clinical problems encountered during treatment in dialysis patients with end-stage renal disease, ranking among the primary determinants of cardiovascular morbidity and mortality. Volume overload plays a central role in the pathogenesis of hypertension in dialysis patients; this is accompanied by activation of the renin-angiotensin-aldosterone system (RAAS), increased sympathetic activity, endothelial dysfunction, and arterial stiffness. Accurate assessment of blood pressure and setting individualized targets become more reliable, especially with measurements reflecting the interdialytic period. Effective volume management, accurate dry weight determination, and optimization of the dialysis prescription form the basis of hypertension control, while antihypertensive drug therapy should be carefully planned in addition to these approaches. The fact that both inadequate and excessive blood pressure control in dialysis patients is associated with a poor prognosis highlights the importance of balanced and individualized hypertension management in this patient group.