Mechanisms of Ramipril Reduction in the Onset of Type 2 Diabetes

Inclusion: * 48 (24 male / 24 female) with impaired glucose tolerance. * Impaired blood glucose values as outlined by the American Diabetes Association guideline. Fasting plasma glucose between 100 and 126 mg/dl or 2 hour post prandial glucose between 140 and 200 mg/dl * BMI \> 25 kgM2 * Age: 20-65 years * Treated or Untreated hypertension defined as measurement of seated BP at screening visit of systolic BP 120 to 150 and/ or diastolic BP 80 to 100. Exclusion: * Patients receiving agents that can increase or lower blood glucose, i.e., metformin, thiazolidinediones, sulfonylureas, glitinides, acarbose, GLP-1 receptor agonists * Untreated or treated while seated Systolic Blood pressure \>150and/or Diastolic Blood pressure \>100 * Taking hypertensive medications of HCTZ or ACE/ARB * Allergy to HCTZ, heparin, nitroglycerin or lidocaine * History of allergy or unacceptable side effects from ACE inhibitors * Pregnancy or intent to become pregnant during the study * Smoking * Subject unable to give voluntary informed consent Physical Exam Exclusion Criteria * Clinically significant Cardiac Abnormalities (e.g. Heart Failure, Arrhythmia) from history or ECG in subjects \> 40 years old * Pneumonia * Hepatic Failure/Jaundice * Renal Failure * Acute Cerebrovascular/ Neurological deficit * Fever greater than 38.0 C Screening Laboratory Tests Exclusion Criteria according to protocol