Aim. To assess the dynamics of the main structural and functional parameters of the left ventricle myocardium condition (LV) in postmenopausal women with arterial hypertension (AH) and different types of obesity: abdominal (AO) and gluteofemoral (GFO), taking combination hypotensive therapy: angiotensin-converting enzyme inhibitor (ACEi) or direct renin inhibitor (DRI). Material and methods. Totally, 168 women studied with AH in postmenopause: 97 with AO and 71 with GFO. Women with different obesity types were randomized to therapy groups as ACEi+diuretic and DRI+diuretic. Follow-up lasted for 24 weeks. Results. Combination therapy that included DRI, led to target values of BP in 90,2% of patients with AO and 90,9% with GFO. Usage of DRI in AO and GFO was followed by significant decrease of wall thickness, left ventricle myocardium mass (MMLV) — by 22,6% and 17,9%, MMLV index — by 23,1% and 18,8%,  respectively, (рu003c0,05), and parameters of diastolic function of LV. On therapy by ACEi+diuretic target values of BP were recorded in 71,4% of AO patients, and in 84,4% with GFO. In 24 weeks of ACEi usage with diuretic in AO and GFO, there was significant change of diastolic LV function (pu003c0,05). Comparative analysis showed that DRI therapy was better comparing to ACEi in AO patients with AO in the sense of the LV structural-functional improvement. Conclusion. Usage of ACEi or DRI in combination with diuretic in postmenopause led to significant cardioprotection not depending on obesity type. In addition, in AO the usage of DRI+diuretic was advantageous comparing to ACEi+diuretic in the sense of hypertrophy regression and LV diastolic function improvement.