Measurement of blood pressure (BP) poses some unique challenges in hemodialysis patients. Timing of BP measurement in relation to dialysis, changes in interdialytic weight gain, and inconsistent BP measurement technique in dialysis units contribute to the variability of BP readings in this population. This may contribute to the equivocal relationship between hypertension and cardiovascular outcomes documented in several epidemiologic studies in this population. Home BP readings are promising, but need to be validated as a measure of the burden of hypertension in this population. It is important to standardize BP measurement in all hemodialysis units according to published guidelines to improve the management of hypertension. Future research studies should carefully validate the technique used to measure BP.