Objective. To study a circadian profile of blood pressure (BP), heart rate variability, and structural and functional remodeling of the left ventricle (LV) in patients with arterial hypertension (HTN) and hypothyroidism, as well as to evaluate the efficiency of various schemes of antihypertensive therapy. design and methods. The study included 150 patients aged 52–75 years: the main group — 31 patients with HTN and primary hypothyroidism in the decompensation stage, the first comparison group — 30 patients with HTN without hypothyroidism, the second comparison group — 22 patients with primary decompensated hypothyroidism without HTN, the third group — 73 patients with HTN and compensated hypothyroidism, and the control group — 14 people without cardiovascular disease, HTN and thyroid disease. Patients with HTN and compensated hypothyroidism received the following antihypertensive therapy for 12 weeks: patients of the 1st subgroup (n = 25) — ramipril and metoprolol succinate, 2nd subgroup (n = 24) — ramipril and amlodipine, 3rd subgroup (n = 24) — metoprolol succinate and amlodipine. At baseline and at follow-up, the levels of thyroid-stimulating hormone and free thyroxine, ambulatory BP monitoring, Holter ECG monitoring, echocardiography were performed. Results. Hypertensive patients with primary decompensated hypothyroidism compared to those without hypothyroidism demonstrated: 1) significantly higher values of systolic and diastolic BP, the time index and the square index at all time intervals, BP variability, and a higher rate of nocturnal hypertension; 2) an increase in the vagal activity, compared to the sympathetic activation in hypertensive patients with compensated hypothyroidism; 3) more pronounced changes in the LV structure and function, higher prevalence of LV concentric remodeling (71 %). Combination therapy of ACE inhibitors and beta-blocker in hypertensive patients with compensated hypothyroidism led to a persistent decrease in BP, as well as to positive changes in LV structure and function, and to an improvement in heart rate variability. Conclusions. Our findings can be used for optimization of HTN in patients with primary hypothyroidism and different thyroid function level.