The clinical effect of pre-operative blood pressure on maturation and failure of arteriovenous fistula (AVF) is important challenge. In this study, we evaluated the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure in end-stage renal disease (ESRD) in Tehran, Iran. In this cross sectional study, 400 patients (264 men and 136 women) with ESRD were assessed after AVF creation and maturation and failure were evaluated. Low diastolic blood pressure before surgery was significantly associated with more AVF failure. SBP was not associated with change in result of failure or maturation in these patients. Higher pulse pressure was accompanied with more failure but it was not significant statistically. Also, we achieved SBP point of 189.5 mmHg with sensitivity and specificity at 67% and 96%, respectively. Using DBP cut-off point of 64 mmHg achieved sensitivity and specificity at 93% and 8%, respectively, and AUC with 95% CI was 0.36 (0.26-0.46). The effect of preoperative blood pressure on maturation was not different among these patients. Our results suggest that preoperative low diastolic blood pressure and wide pulse pressure can be associated with more AVF failure in comparison with patients without these risk factors.