This study compared the use of antihypertensive treatment and blood pressure (BP) controls between patients with diabetic kidney disease (DK+) and patients with non-diabetic kidney disease (DK-) exhibiting moderate-to-severe chronic renal failure who did not need renal replacement therapy. A cross-sectional survey included all renal patients with s-creatinine at > 200 µmol/L attending regular control sessions at 6 renal units in Norway. Of the 351 patients included, 73 (20,8%) were DK+. The proportion reaching a BP goal of < 130/80 mmHg was similar in DK+ and DK- (14.1 % vs 13.6 %, p = 0.92), while 38% and 39% achieved a BP of < 140/90 mmHg, respectively. The systolic BP goal was more difficult to achieve than the diastolic BP goal in DK+ patients (35% vs.15%) despite a mean of three different types of drugs being used. Loop diuretics and beta-adrenergic-receptor antagonists were the most frequently prescribed drugs, and the use of angiotensin-converting enzyme inhibitors or angiotensin-II-receptor antagonists declined when renal function deteriorated, from 80% to 0% and from 66% to 20% in the DK+ and DK- groups, respectively (p = 0.001). Thus, despite the use of multiple antihypertensive drugs, controlling BP - especiallly the systolic BP - is difficult in high-risk patients with chronic renal failure, caused by diabetic kidney disease.