Hypertension is major comorbidity yet difficult to manage in hemodialysis patients. Pharmacist’s role to improve the clinical outcome of hypertensive hemodialysis patients needs to be evaluated. The study objective was to evaluate the effect of pharmacist counseling in lowering systolic and diastolic blood pressure in hypertensive hemodialysis patients in hemodialysis unit of Fatmawati Hospital Jakarta in 2018, by controlling some confounders. The study used a quasi-experimental design with pretest-posttest, conducting on age, gender, education, smoking habit, and payment method-matched intervention and control groups. The research sample was taken by consecutive sampling method for 30 patients in the intervention group and 28 patients in the control group. Pharmacist counseling was carried out only in the intervention group. The parameter used were predialysis, intradialysis, and postdialysis systolic and diastolic blood pressure. The results showed that there were significant differences in pretest and posttest (p < 0.05) for predialysis systolic and diastolic blood pressure in the counseling group. In multivariate analysis with backward method, pharmacist counseling was found to be the most determinant factor in reducing predialysis systolic blood pressure (p < 0.05) controlled by education level. It also significantly reduced predialysis diastolic blood pressure controlled by gender, intradialysis systolic blood pressure, and intradialysis diastolic blood pressure controlled by age. The conclusion of the study is pharmacist counseling was the most determinant factor in lowering pre- and intradialysis blood pressure in the hypertensive hemodialysis patient.