Hypertension and a high incidence of cardiovascular morbidity and mortality often accompany end-stage renal disease. Causes of the hypertension include abnormalities of extracellular fluid volume, increased activity of the renin-angiotensin system, dysfunction of the autonomic nervous system, and deficiency of vasodilator substances. Treatment is not detrimental to residual renal function and may enhance the quality of survival. Several types of therapy are available that may be used sequentially or in combination. New antihypertensive drugs and improved blood-cleansing devices allow a more optimistic outlook on long-term survival in end-stage renal disease.