Hypertension, diabetes and visceral adiposity are very common co-morbidities with an exceedingly high risk of cardiovascular and renal complications. Therefore, emphatic treatment is necessary. Blood pressure goal is recommended below 130/80 mmHg with office measurements, and less than 7 out of 30 values below 135/85 mmHg with home measurements. Strict blood pressure control reduces macro- and microvascular morbidity. Usually combination of different drugs is necessary to achieve a satisfactory blood pressure control. First line should be an inhibitor of the RAS, commonly combined with a calcium channel blocker and/or a diuretic. Fixed-dose combinations are recommended. If indicated or necessary, newer generation betablockers may be given as an adjunct. Life style measures and active reduction of further risk factors are essential.