African American, Hispanic, South Asian, and Pima Indian populations are at high risk for cardiovascular mortality and morbidity, partly owing to greater prevalence of diabetes and obesity. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are the treatment of choice for patients with diabetes at high risk for cardiovascular events. Early reports suggest dual renin-angiotensin system blockade is as effective as monotherapy in high-risk patients; further studies will determine if it increases cardioprotective effects in patients with chronic kidney disease, diabetes, and heart failure.