Hypertension is a prevalent and challenging comorbidity in patients with diabetic kidney disease (DKD), contributing significantly to cardiovascular risk and the progression of renal disease. This case report discusses the primary care management of a middle-aged woman with hypertension and DKD who, despite adhering to triple antihypertensive therapy, continues to have uncontrolled blood pressure (BP). The clinical report explores evidence-based strategies for optimizing BP control while decreasing kidney disease progression. Dietary sodium restriction is highlighted as a particularly effective intervention for lowering BP in patients with volume-overloaded DKD. Angiotensin inhibition remains the cornerstone of therapy because of its renal and cardiac benefits, but additional antihypertensive agents are often necessary to achieve target BP levels. Long-acting thiazide or loop diuretics, along with calcium channel blockers and steroidal mineralocorticoid receptor antagonists, are recommended as additional pharmacological options to lower BP while reducing albuminuria. The newly approved nonsteroidal mineralocorticoid receptor antagonist, finerenone, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists have been shown to offer kidney- and heart-healthy benefits, making them integral to treatment strategies. Routine monitoring of BP, serum creatinine, estimated glomerular filtration rate, potassium, and albuminuria is critical to guiding treatment adjustments. This case underscores the necessity of a patient-centered approach to managing hypertension in DKD. By using a comprehensive strategy, primary care nurse practitioners can improve BP control, slow renal disease progression, reduce cardiac events, and prolong the life of these high-risk patients.
