Certain patients with type 2 diabetes mellitus (DM) do not have increased cardiovascular (CV) risk. The aim of the present study was to stratify hypertensive adults with DM into those with low or high CV risk according to the absence or presence of coronary artery calcium (CAC). The study group included 423 patients, a subgroup of the 544 participants in the calcification side arm of the International Nifedipine Study: Intervention as Goal for Hypertension Therapy. All underwent a baseline computed tomography scan with an unenhanced dual-detector spiral computed tomography scan for CAC measurements. All were free of CV disease and completed 3 years (short-term) of follow-up. A total of 268 patients were included in the 15-year (long-term) follow-up period. The study group was divided into 4 subgroups according to the presence or absence of DM and CAC and was analyzed for a first CV event. Of the 423 patients, 164 (39%) had DM. Cardiovascular events occurred in 41 patients during the first 3 years and in 111 of 268 patients during the long-term follow-up. The rate of CV events was greater in the patients with DM with CAC than in those without (15% vs 7% after 3 years and 52% vs 32% after 15 years). Compared to those without DM without CAC, the short-term adjusted hazard ratio for CV event in those with DM with and without CAC was 6.6 (95% confidence interval 1.4 to 30.5) and 3.9 (95% confidence interval 0.7 to 22.6), respectively. A similar trend was seen in the long-term follow-up study. In conclusion, patients with hypertension and DM can be stratified into a lower CV risk in the absence of CAC.