Insulin resistance is not simply a problem of decreased glucose uptake in response to insulin, but a multifaceted syndrome that significantly increases the risk for cardiovascular disease. Insulin resistance is strongly associated with arterial hypertension and a pathogenetic role in the development of arterial hypertension has been suggested. One question that remains open concerns the clinical approach to insulin-resistant patients. Observational and clinical trial data suggest that lifestyle changes including weight reduction and regular physical activity can improve insulin sensitivity and reduce the incidence and mortality of cardiovascular disease. Daily physical activity of moderate intensity for 30 min has a cardioprotective effect and reduces insulin resistance, independent of the effect on body weight. A pharmacological therapy for insulin resistance reducing cardiovascular disease remains to be defined. Concerning the antihypertensive therapy of insulin-resistant hypertensive patients, most hypertensive guidelines fail to provide specific advice.