Background: Hyperhomocysteinemia increases risk of morbidity and mortality secondary to cardiovascular diseases such as increased risk of atherosclerosis, ischemic heart disease and peripheral vascular disease and has been associated with microalbuminuria in type II diabetes mellitus. Subjects and Methods: 100 patients, 50 hypertensive diabetic patients, 50 normotensive diabetic patients, and 20 patients as control group matched for age, gender and body mass index (BMI) and were clinically assessed and laboratory investigations were done through estimation of plasma homocysteine, lipid profile, fasting and two hours post prandial blood glucose, and serum creatinine. Results: Homocysteine was elevated more in hypertensive diabetic group than diabetic group with high significant correlation (P=0.001), moreover homocysteine was highly significant correlated to BMI fasting blood glucose, cholesterol, serum triglyceride (P=0.001), and insignificant correlation to serum creatinine in both goups. Conclusion: Homocysteine is a significant risk factor in hypertensive diabetic patients. Using folic acid supplement 0.4mg daily is essential to reduce level of serum homocysteine especially in hypertensive, diabetic patients to decrease risk of cardiovascular events in addition of controling blood pressure, blood sugar and obesity.