Diabetes Mellitus (DM) confers an increase of cardiovascular risk, independently from other conventional risk factors. The risk of cardiovascular events is 4-fold higher in patients with both diabetes and hypertension, compared with the normotensive controls. Compared with data from the general population or hypertensive individuals, a higher frequency of Resistant Hypertension (RH) has been observed in subjects with type 2 diabetes. Moreover, subjects with resistant hypertension had a higher prevalence of diabetes as compared with patients treated and controlled with three or less drugs. In this review, the burden of RH in subjects with diabetes and the ratio between benefit and risk of spironolactone according to the renal function and or Hyperkalemia has been examined. In addition, this review focus in the possible role of new non-pharmacological techniques used in recent years in the control the RH, and its effect on office blood pressure and the most controversial and heterogeneous effects on ambulatory BP. Some studies have shown promising results on the metabolism of glucose and insulin repetition, but these promising results need to be confirmed in large randomized studies.
