Controlling sodium and volume overload, using prolonged or frequent dialysis to alleviate excessive intradialytic RAS and SNS activation, the wise use of specific antihypertensive classes, most commonly used calcium channel blockers, alpha-blockers, ACE inhibitors, and angiotensin receptor blockers to aliskiren and minoxidil, or even renal denervation in patients truly unresponsive to multiple drug therapy and dialysis optimization are all options until more specific evidence targeting mechanistic pathways of intradialytic hypertension becomes available. This evidence concerns the gene ACE and hypertensive disorder.