Diabetes and hypertension frequently coexist, and their combination provides additive increases in the risk of life-threatening cardiovascular events. Recent guidelines agree on the need for early, aggressive reduction of blood pressure, with a goal of <130 0="" mmhg,="" in="" patients="" with="" diabetes.="" the="" mechanism="" that="" underpins="" the="" increased="" sensitivity="" of="" diabetic="" subjects="" to="" hypertension="" is="" not="" known,="" but="" may="" involve="" impaired="" autoregulation="" or="" attenuated="" nocturnal="" decrease="" of="" blood="" pressure.="" all="" classes="" of="" antihypertensive="" agents="" are="" effective="" in="" reducing="" blood="" pressure="" in="" diabetic="" subjects,="" and="" all="" show="" evidence="" of="" a="" concomitant="" reduction="" in="" cardiovascular="" risk.="" although="" there="" is="" some="" evidence="" that="" agents="" that="" interrupt="" the="" renin–angiotensin="" system="" (ras)="" provide="" greater="" protective="" effects,="" the="" data="" are="" not="" conclusive.="" however,="" most="" diabetic="" subjects="" will="" require="" combination="" therapy="" to="" reach="" goal="" blood="" pressure.="" antihypertensive="" drugs="" can="" also="" significantly="" influence="" the="" probability="" that="" otherwise="" healthy="" individuals="" will="" develop="" metabolic="" syndrome="" or="" type="" 2="" diabetes.="" while="" diuretics="" and="" betablockers="" have="" a="" prodiabetic="" effect,="" angiotensin–converting="" enzyme="" inhibitors="" and="" angiotensin="" ii="" receptor="" blockers="" may="" prevent="" diabetes="" more="" effectively="" than="" the="" metabolically="" neutral="" calcium="" channel="" blockers.="" given="" that="" diabetes="" is="" an="" important="" cardiovascular="" risk="" factor,="" there="" is="" the="" potential="" for="" reductions="" in="" risk="" due="" to="" reduced="" blood="" pressure="" to="" be="" offset="" by="" an="" increased="" risk="" due="" to="" the="" development="" of="" diabetes.="" such="" concerns="" should="" be="" considered="" in="" the="" selection="" of="" antihypertensive="">