Objective To explore the application effect of cluster intervention in patients with hypertension after maintenance hemodialysis (MHD) so as to provide reference for the optimization of clinical nursing plans. Methods A total of 160 patients with hypertension undergoing MHD in the hospital were enrolled between January and December 2024. According to random number table method, they were divided into observation group (cluster intervention, n=80) and control group (routine nursing, n=80). The self-efficacy [Self-Efficacy for Managing Chronic Disease 6-Item Scale (SECD6)], blood pressure control, blood glucose fluctuation and complications in the two groups were compared. Results After 3 months of intervention, scores of SECD6(common management confidence, common management behavior) and total score in observation group were (17.05±1.67) points, (30.42±3.25) points and (47.47±4.92) points, higher than those in control group [(14.43±2.29) points, (24.93±3.78) points, (39.36±6.07) points; P<0.05]. After 3 months of intervention, systolic blood pressure and diastolic blood pressure in observation group were (127.93±13.45) mmHg and (87.65±7.93) mmHg, lower than those in control group [(135.07±14.96) mmHg, (92.94±8.61) mmHg; P<0.05]. After 3 months of intervention, mean amplitude of glycemic excursion and largest amplitude of glycemic excursion in observation group were (1.92±0.50) mmol/L and (3.06±0.93) mmol/L, lower than those in control group [(2.32±0.58) mmol/L, (3.98±1.06) mmol/L; P<0.05]. The incidence of complications in observation group was lower than that in control group (6.25% vs 16.25%, P<0.05). Conclusion Cluster intervention can improve self-efficacy, effectively control blood pressure, improve blood glucose fluctuation and reduce complications in MHD patients with hypertension.