Vascular access dysfunction is a major cause of morbidity among maintenance hemodialysis (HD) patients. Calcium channel blockers (CCBs) may affect vascular remodeling; however, their impact on arteriovenous fistula (AVF) flow rate remains uncertain. We evaluated the association between antihypertensive therapy, particularly CCBs, and AVF flow rate in maintenance HD patients. In this cross-sectional study, 79 HD patients were categorized into those receiving antihypertensive medications (n = 58) and those not (n = 21) - subgroup analyses compared CCBs (n = 26) and beta blocker (BBs) users (n = 23). AVF Doppler ultrasound parameters, including flow rate, were analyzed. Multivariable regression assessed associations between treatment groups and AVF flowrate adjusting for age, sex, dialysis vintage, diabetes mellitus (DM), calcium level, and cardiac disease. Median AVF flow rate was comparable between CCBs users and BBs users (971 [803-1739] vs. 1227 [937-1519] mL/min, p = 0.348). In adjusted analyses, CCBs therapy was not independently associated with AVF flow rate (β = -8.41 mL/min; 95% CI: -432.07,415.25; p = 0.968) or other vascular parameters. Age was inversely associated with AVF flow (β = -14.2; p = 0.013), while DM showed a non-significant trend toward higher flow (β = 306; p = 0.17). Older age was inversely associated with prior AVF failure (OR = 0.95; p = 0.024), whereas vascular access type and duration were not significant. CCBs use was not associated with differences in AVF flow rate, however, its use may confer protection against AVF failure. Prospective studies are needed to confirm these findings and explore effects of antihypertensive classes on vascular access outcomes.