Hypertension prevalence is high in both hemodialysisand peritoneal dialysis patients. Among several possiblemechanisms leading to hypertension in chronickidney disease, the most important is the positive balanceof sodium and accumulation of extracellular fluidcausing cardiovascular remodeling. Hypertension mayprovoke de novo left ventricular hypertrophy and cardiacfailure in dialysis patients and is also associatedwith a higher risk of stroke. The relationship betweenhypertension and mortality is unexpected, with bettersurvival in hypertensive patients in short-term studiesin which heart failure associated with low blood pressureand high death rate confounds the effect of hypertensionon death risk. Higher mortality is found inhypertensive patients surviving beyond 2 years underdialysis treatment. The nonpharmacological treatmentof hypertension – the dry weight method – is efficientto correct hypertension when applied. A recent randomizedcontrolled trial has confirmed its efficiencyin lowering blood pressure. A low-salt diet is part ofthis strategy limiting the interdialytic weight gain andenhancing tolerance to ultrafiltration. Moreover, accordingto recent meta-analyses, the prescription ofantihypertensive medications is associated with bettersurvival. Their appropriate use remains to be studied.In conclusion, the important challenge for the nephrologistin 2009 is to efficiently correct extracellularfluid overload and its consequences, with the goal ofimproving the high burden of cardiovascular mortalityamong dialysis patients.