Higher Dose of Ramipril Versus Addition of Telmisartan-Ramipril in Hypertension and Diabetes

Inclusion Criteria: * Male or female over the age of 18 years * Diastolic blood pressure (DBP) greater tha 80 mmHg and less than 104 mmHg * Type II diabetes on diet or oral hypoglycemic agents with a hemoglobin A1C (HbA1C) less than 0.080 * UA ratio albumin:creatinine 2.0 to 25 mg/mmol Exclusion Criteria: * DBP \> 104 mmhg * Woman not surgically sterile or menopausal. * Premenopausal women whoo are not surgically sterile or who are not practicing acceptable means of birth control and do not agree to submit to periodic pregnancy tests. * Known or secondary forms of hypertension. * Intolerance to angiotensin (AT) 1 receptor blockers or angiotensin-converting enzyme (ACE) inhibitors. * Hepatic or renal dysfunction. Creatinine \> 150 umol or enzymes greater than 2 times upper limit of normal. * Hemodynamically significant renal artery stenosis, renal artery stenosis on a solitary kidney, post-renal transplant or with only one kidney. * Uncorrected volume depletion. * Biliary obstructive disorders. * NYHA functional class congestive heart failure (CHF) III-IV. * Coronary heart disease needing pharmacological therapy. * Stroke within the preceding six months. * Percutaneous transluminal coronary angioplasty (PTCA) within the preceding three months. * History of angioedema. * Sustained ventricular tachycardia, atrial fibrillation, or other clinically relevant cardiac arrhythmias as determined by the clinical investigator. * Second or third degree AV block, left bundle branch block or any clinically relevant conduction abnormality as determined by the clinical investigator. * Hypertrophic obstructive cardiomyopathy, aortic stenosis, hemodynamically relevant stenosis of aortic or mitral valve. * Administration of digoxin. * Patients with a fasting glucose greater than 7.0 * History of drug or alcohol dependency. * Use of antihypertensive agents such as diuretics, ACE inhibitors, angiotensin II antagonists, alpha-blockers, beta-blockers, calcium channel antagonists, direct vasodilators that cannot be stopped for the trial. * Administration of other non-antihypertensive medications known to affect blood pressure (e.g. oral corticosteroids, monoamine oxidase \[MAO\] inhibitors, nitrates) at any time during the trial. * Chronic use of salt substitutes containing potassium chloride; potassium supplements; extreme dietary restrictions. * Uncorrected sodium depletion as defined by a serum sodium level less than 135 mEq/L. * Clinically significant hyperkalemia as defined by serum potassium level greater than 5.2 mEq/L. Clinically significant hypokalemia as defined by serum potassium level less than 3.0 mEq/L. * Patients receiving any investigational therapy within one month of signing the informed consent form. * Known hypersensitivity to any component of telmisartan, ramipril or hydrochlorothiazide. * Any other clinical condition which, in the opinion of the principal investigator, would not allow safe completion of the protocol and safe administration of trial medication. * Blood donation in the preceding 1 month.