Patients with diabetes have a markedly increased cardiovascular risk, making blood pressure control a cornerstone of prevention. The 2024 ESC Guidelines emphasize early treatment even in patients with elevated blood pressure, guided by global cardiovascular risk assessment and tools such as SCORE2-Diabetes. Evidence from major trials, including ACCORD-BP, SPRINT, STEP, ESPRIT and BPROAD, supports lower blood pressure targets (120–129/70–79 mmHg) when treatment is well tolerated. Combination therapy, preferably as fixed-dose combinations, improves efficacy and adherence. In resistant hypertension spironolactone remains the preferred add-on therapy, while SGLT2 inhibitors may provide additional benefit in the presence of chronic kidney disease or heart failure. In selected cases, renal denervation is emerging as a complementary therapeutic option when optimal medical therapy fails.