The authors examined the efficacy of antihypertensive medication use in end-stage renal disease (ESRD). They compared achieved blood pressures (BPs) in a cross-sectional study of 106 ESRD patients whose medications had not been changed for at least 2 months. Group 1 (n=36) included patients who took 0 or 1 medication; group 2 (n=56), 2 or 3 medications; and group 3 (n=14), > or =4 medications. The population's mean age was 55.1 years, 87% were African American, and 57% were men weighing 76.9 kg who were on 229 minutes of hemodialysis with an edKt/V of 1.35; there was no difference between the 3 groups. The authors found a difference in the mean BPs: 139/72 mm Hg in group 1, 154/82 mm Hg in group 2, and 165/91 mm Hg in group 3 (P=.01 for systolic, P=.002 for diastolic), with a mean arterial pressure difference of 94.4, 106.4, and 115.4 mm Hg (P=.002). The authors conclude that in this group of primarily African American patients, the control of hypertension in ESRD is not achieved by escalating the number of antihypertensive medications.