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)