The Home Blood Pressure (BP) Trial

The main study will be a two arm 10-month, cross-over randomized controlled trial of 200 participants treated with end-stage-kidney-disease treated with in-center hemodialysis in the Seattle and San Francisco area comparing a strategy of targeting home vs. pre-dialysis systolic blood pressure \

Inclusion Criteria: * Aged 18 years or older * Undergoing in-center, thrice weekly hemodialysis for treatment of end stage renal disease (ESRD) * Greater than 3 months since initiation of dialysis * No anticipated change to peritoneal dialysis or kidney transplant within 10 months * Life expectancy greater than 10 months * Hypertension (defined as mean pre-dialysis SBP \> 140 mmHg over prior 2 weeks or taking BP medications) * Able to obtain/measure a brachial blood pressure at dialysis and at home (e.g., no left ventricular assist device, blood pressure not been taken routinely in lower extremity at dialysis unit) * No condition that the primary nephrologist or PIs feel precludes participation Exclusion Criteria: * Incarcerated or institutionalized (prohibits home blood pressure measurement) * Participating in another intervention study that may affect blood pressure * Pregnant or anticipated pregnancy or breastfeeding (as this will require increase to more than three times a week dialysis and/or preclude use of some classes of blood pressure medications)