This observational study aimed to analyze the effects of rational dietary adjustment on the nutritional health status of patients with hypertension complicated by type 2 diabetes. This study retrospectively analyzed clinical data from 77 patients with hypertension and type 2 diabetes treated at our hospital. Patients underwent a 6-week rational dietary adjustment intervention, comprising dietary guidance adjustment in weeks 1-2, concentrated implementation in weeks 3-4, and self-execution in weeks 5-6. Food frequency surveys and 24-h dietary recalls assessed pre- and post-intervention dietary structure and nutrient intake. Changes in body composition, blood glucose indicators, and blood pressure control were observed. Pos-intervention, patients showed decreased intake of soy nuts, pickled products, fried foods, and salt, while intake of fresh fruits, fresh milk, and dairy products increased (P < 0.05). Fat and sodium intake decreased, while intake of dietary fiber, potassium, magnesium, and calcium increased (P < 0.05). SBP, DBP, PBG, TC, and LDL-C levels decreased (P < 0.05), with improved PBG and blood pressure control rates (P < 0.05). Rational dietary adjustment intervention in patients with hypertension complicated by type 2 diabetes has ideal effects, helping patients change their irrational dietary structure and improve their nutritional status.