Hypertension in chronic hemodialysis patients is very common, and associated with cardiovascular morbidity and mortality. On the other hand, normalization of blood pressure in this patient population results in improvement of survival in the long-term. Drug therapy for hypertension in hemodialysis patients includes mainly angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers and diuretics, but guidelines for the use of specific classes of antihypertensive medications do not exist for end-stage renal disease (ESRD) patients on maintenance hemodialysis treatment. In survival analyses, some studies are in favour for the ACE inhibitors, other studies report reduced risk of cardiovascular mortality by using calcium channel blockers. Beta blockers seem to be ideal antihypertensive agents, since sympathetic nerve activity is inappropriately increased in ESRD patients. Most studies indicate that hypertension control is still not adequate in the majority of chronic hemodialysis patients. Randomized, controlled clinical trials are needed to determine the most advantageous antihypertensive agent(s) to use in ESRD patients on chronic hemodialysis therapy.