This study examined the effects of an educative, self-regulation intervention on blood pressure self-efficacy, self-care outcomes, and blood pressure control in adults receiving hemodialysis. Simple randomization was done at the hemodialysis unit level. One hundred eighteen participants were randomized to usual care (n = 59) or intervention group (n = 59). The intervention group received blood pressure education sessions and 12 weeks of individual counseling on self-regulation of blood pressure, fluid, and salt intake. There was no significant increase in self-efficacy scores within (F = .55, p = .46) or between groups at 12 weeks (F = 2.76, p = .10). Although the intervention was not successful, results from the total sample (N = 118) revealed that self-efficacy was significantly related to a number of self-care outcomes including decreased salt intake, lower interdialytic weight gain, increased adherence to blood pressure medications, and fewer missed hemodialysis appointments. Increased blood pressure self-efficacy was also associated with lower diastolic blood pressure.