Living with CKD
High Blood Pressure, Diabetes and Your Kidneys
This article is general information. Your nephrologist or renal dietitian knows your lab results and can tell you what is right for you.
NIDDK names diabetes and high blood pressure as the two most common causes of chronic kidney disease (CKD) in adults. It reports that diabetes causes 38% of kidney failure in the United States and high blood pressure causes 26%. This article explains the links in general terms. It does not set targets or treatments for you, which are decided with your care team.
High blood pressure and the kidneys
The National Kidney Foundation (NKF) explains that the connection runs both ways. Over time, high pressure can damage the small blood vessels in the kidneys that filter waste. Damaged kidneys, in turn, may struggle to remove extra salt and water, which raises blood pressure. NIDDK describes this as a cycle that can eventually lead to kidney failure. Because high blood pressure usually causes no symptoms, checking it is the only way to know.
The NKF gives these categories: normal is under 120/80 mmHg; elevated is 120 to 129 systolic and under 80 diastolic; stage 1 hypertension is 130 to 139 systolic or 80 to 89 diastolic; stage 2 is 140 or higher systolic or 90 or higher diastolic. A diagnosis is based on an average of two or more readings, often across more than one visit.
Goals differ between organizations and have changed over the years. The NKF says the usual treatment goal is below 130/80 for most adults, including those with kidney disease, and that individual goals vary; older NIDDK pages mention below 140/90. Your own goal is set by your doctor.
Diabetes and the kidneys
NIDDK describes diabetic kidney disease as kidney disease caused by diabetes and says about 1 out of 3 adults with diabetes has kidney disease, citing CDC data. High blood glucose can damage the blood vessels in the kidneys, and high blood pressure, which many people with diabetes also develop, can add to the damage. The damage usually develops slowly, over many years, and most people with it have no symptoms. NIDDK notes that most people with diabetes and kidney disease do not develop kidney failure.
Annual testing is recommended for people with type 2 diabetes, and for people with type 1 diabetes who have had it for more than 5 years. The tests are a urine test for albumin and a blood test for kidney filtering; see Kidney Function Tests.
What official sources say about protecting the kidneys
NIDDK’s page on diabetic kidney disease lists reaching blood glucose goals (the A1C goal for many people with diabetes is below 7 percent, individualized by the provider), controlling blood pressure, not smoking, limiting salt and sodium, following a diabetes meal plan, being physically active, keeping a healthy weight and getting 7 to 8 hours of sleep. It says ACE inhibitors and ARBs, medicines whose names end in -pril or -sartan, have been found to slow kidney damage in people with diabetes, high blood pressure and kidney disease, and that they are not safe during pregnancy.
The NKF describes the main classes of blood pressure medicine used in CKD: ACE inhibitors or ARBs, calcium channel blockers and diuretics, and notes that many people need more than one. It also says home readings with a validated upper-arm monitor can help, and that people should avoid potassium-based salt substitutes unless their healthcare team approves them.
Be careful with over-the-counter medicines
The NKF cautions that some over-the-counter medicines and supplements, such as NSAIDs, can raise blood pressure, and NIDDK says regular NSAID use can damage the kidneys. Ask a pharmacist or doctor before using them.
When to get urgent help
The NKF says very high blood pressure with symptoms such as chest pain, trouble breathing, sudden weakness or numbness, speech trouble or sudden vision changes is an emergency. Call your local emergency number.
For the bigger picture, read What Is Chronic Kidney Disease? and Newly Diagnosed With CKD.
Related reading
Sources
- National Kidney Foundation: High Blood Pressure and Chronic Kidney Disease, updated August 13, 2026
- NIDDK: High Blood Pressure and Kidney Disease
- NIDDK: Diabetic Kidney Disease
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