This takes up to 20 years to occur. Atherosclerosis begins when insulin resistance begins. Insulin resistance plus endothelial dysfunction leads to more risk for hypertension. These people can have left ventricular hypertrophy with seemingly normal blood pressures at rest. This is called white coat normotension.
ACE inhibitors are vascular protective in diabetics.
They have also been shown to reduce the development to diabetes in some with insulin resistance. Start meds if the diabetic is running a blood pressure above this. The only two drugs that can make insulin resistance worse are diuretics and beta blockers. Most people with essential hypertension have got insulin resistance. Losing weight and increasing physical activity can improve insulin resistance dramatically.