Despite remarkable declines in US cardiovascular disease morbidity and mortality over the last several decades, the prevalence of risk factors such as type 2 diabetes and hypertension remains high, associated with increasing obesity rates. Although optimal glycemic control remains a primary focus to decrease the disease burden, the FDA has issued guidance recommendations for documenting cardiovascular disease-related safety with research trials on new antidiabetic agents with more demanding requirements compared to past approval of existing therapies. This review will discuss the public health impact of type 2 diabetes, specifically with comorbid hypertension; mechanisms of action of the newest antidiabetic drug classes; and preliminary findings and potential clinical significance of the favorable blood pressure and body weight effects of the sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists; and additionally discuss two recent large cardiovascular outcome trials with dipeptidyl peptidase-4 inhibitors.