Do you prefer maximizing fluid removal during dialysis or starting new antihypertensive medications for patients with ESKD on intermittent hemodialysis who are chronically hypertensive?

Fluids, fluids, and fluids are the most crucial first step. Challenging dry weight is the most important part in controlling blood pressure, and then adding more blood pressure medications is the next step. The only "exception" is high dose diuretics to reduce intradialytic weight gain.

Additionall...

Definitely maximizing fluid removal. The problem is that it is not always easy to achieve. Many times, there is a delayed response (fluid is removed, and it takes 2-3 months for the blood pressure to come down). If I hit a roadblock in removing fluid, then I adjust the medications.

I find it easy to remove fluids if the PCP does not interfere and some Nephrologist do not interfere and add extra blood pressure medication that are totally not needed and hamper ability to remove fluids.