In Type 2 diabetes, microalbuminuria, a marker of generalized vascular dysfunction, and hypertension have been linked with both renal and cardiovascular damage. To investigate the effect of moderately elevated blood pressure on vascular damage, TERalb was measured by i.v. injection of 1 2 5 I-human serum albumin, in 9 healthy controls (G1), 9 non-diabetic hypertensive subjects (G2) and 73 non-obese type 2 diabetic patients stratified as follows: G3: 17 normoalbuminuric-normotensives; G4: 22 normoalbuminuric-hypertensives (SBP ≥ 140 or DBP ≥ 90 mmHg or both); G5: 16 normotensives with microalbuminuria (AER 20-200 μg/min) and G6: 18 microalbuminuric-hypertensives. Groups 3-6 were similar as for age, gender, diabetes duration (G3: 7.8 ± 5.5; G4: 9.7 ± 8.7; G5: 12.1 ± 8.1 and G6: 10.7 ± 8.3 years), BMI, HbA1c (7.8 ± 1.1; 7.5 ± 1.5; 8.7 ± 1.5 and 7.7 ± 1.1%, respectively), blood glucose and lipids. Systolic and diastolic BP did not differ in the three hypertensive groups (G2: 154 ± 399 ± 6, G4: 149 ± 1395 ± 6, G6: 154 ± 1519 ± 9 mmHg), and were significantly lower (p < 0.001) in G3 (126 ± 1276 ± 7), G5 (128 ± 1177 ± 5) and controls (G1: 133 ± 781 ± 4). TERalb was similar in controls (5.77 ± 1.06%/h) and in normoalbuminuric-normotensives (5.81 ± 1.51%/h) but significantly higher (p < 0.0001) in microalbuminuric subjects with or without hypertension (9.11 ± 1.65 and 8.60 ± 1.50%/h, respectively) as well as in normoalbuminuric diabetics with hypertension (8.10 ± 2.27%/h) and in essential hypertensive subjects (8.12 ± 1.68%/h). By stepwise regression, TERalb was related (step 1) to log-AER (r = 0.30) or to presence of microalbuminuria (r = 0.36), and (step 2) to dBP (multiple r = 0.40) or to presence of hypertension (r = 0.51) in the whole diabetic cohort (G3-6). TERalb was related to dBP (r = 0.47) or to presence of hypertension (r = 0.56) only in normoalbuminuric diabetics (G3-4) and to logAER only (r = 0.56) or to presence of microalbuminuria (r = 0.68) in normotensive patients (G3 and G5). In Type 2 diabetic patients, TERalb was elevated in subjects with rised albuminuria irrespective of blood pressure levels, but also independently related to the presence of mild to moderate systemic hypertension.