Hypertension and diabetes mellitus frequently occur together, leading to increased complications and mortality in patients with both these conditions. Blood pressure (BP) goals for patients with diabetes have consistently been more aggressive than those for patients without diabetes. Although the benefits of lowering BP in hypertensive patients are well documented, data to support these more aggressive goals are lacking. In fact, lowering BP might not always be better. On the basis of available evidence from placebo-controlled trials, randomized trials, and achieved BP analyses, the target BP levels recommended in current guidelines (<130/80 mmHg) are not supported for the prevention of macrovascular outcomes in patients with diabetes. Consideration should be given not only to patients’ current BP levels, but also to their underlying level of overall risk before assigning a BP-treatment target. Current data support BP lowering to <140 mmHg systolic in patients with and without diabetes. Additionally, other risk factors should be managed in each patient as appropriate, including smoking cessation, weight loss, blood glucose management, and cholesterol management, to reduce overall long-term cardiovascular risk. Due to beneficial interference with the metabolic derangements seen in diabetic patients with hypertension, telmisartan may have a special role for hypertension control in such patients.