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Patients with prediabetes have impaired fasting glucose, impaired glucose tolerance, and the metabolic syndrome. They have similar coronary heart disease risk rates as patients with type 2 diabetes. Goals and agents for blood pressure and lipid management should be the same for patients with prediabetes as those for patients with overt diabetes. Multiple antihypertensive agents are likely necessary for normotension. Aggressive statin usage is the first-line lipid therapy and concomitant fibrate and nicotinic acid usage should be reserved for failures in primary prevention. J Clin Hypertens (Greenwich). 2011;13:270–274. © 2011 Wiley Periodicals, Inc.