People with end stage kidney disease receiving dialysis have a very risk of cardiovascular disease and mortality. Hypertension is a modifiable risk factor for cardiovascular disease and mortality, affecting around 90% of dialysis patients. Conversely, intradialytic hypotension in haemodialysis patients is associated with debilitating symptoms as well as the risk of cardiovascular disease and mortality. Blood pressure management in dialysis patients involves accurate measurement of blood pressure, setting a target blood pressure, adequate fluid volume management, lifestyle changes, modification of dialysis and dialysate, and the use of medication with proven efficacy in these patients. However, globally there is no published contemporary clinical practice guideline to assist health care professionals to manage blood pressure in dialysis patients. This is mainly because of a dearth of good quality evidence to inform guideline recommendations. Here, we present a comprehensive guideline to manage blood pressure in dialysis patients based on a thorough systematic review of literature. The guideline development committee comprised a multidisciplinary group of nephrology healthcare professionals and a patient. The evidence underpinning the guidance is often of moderate to low quality, influencing the strength of the recommendations. Therefore, the committee have come up with a list of research recommendations with a view to informing future guidelines. It is envisaged that this guideline will improve the care and outcomes of dialysis patients in the UK and elsewhere.