This retrospective study included 1051 patients with end‐stage kidney disease and Brescia‐Cimino arteriovenous fistula (AVF) (excluding pre‐dialysis patients), and aimed to investigate the role of blood pressure in AVF primary failure. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured twice daily for 3 days before surgery. The success (N = 1010) and failure (N = 41) groups were based on AVF primary failure within 7 days of surgery. The cephalic vein was larger and the preoperative mean arterial pressure (MAP) was higher in the success group compared with the failure group (P < 0.05). Cephalic vein diameter and preoperative MAP independently predicted AVF primary failure within 7 days after surgery. In conclusion, small cephalic vein diameter and low preoperative MAP were associated with AVF primary failure within 7 days of surgery.