The aim of present study was to assess antihypertensive efficacy of ramipril 5-10 mg (Hartil "EGIS", Hungary) and its influence on hemodynamical changes and vessel endothelial function in old and elderly patients with isolated systolic hypertension. 32 patients were studied. The duration of the therapy was 6 months. 24-hour blood pressure monitoring was performed and left ventricular parameters, systolic, diastolic function and endothelial function of brachial artery (endothelium - dependent vasodilatation), blood tests, lipid profile were investigated before and after 3 and 6-months of treatment. The study detected high antihypertensive efficacy of Hartil: mean daily and pulse pressure were significantly (p<0,001) decreased after 3 and 6-months of treatment (TA(syst) 9,1 and 16%, TA(diast) 2,2 and 8,4%, pulse pressure 2,2 and 7,5%, respectively), beneficial effect revealed on 24-hour blood pressure profile: number of patients with normal dipper profile increase from 33 to 46% with decrease of number of non-dippers and night-peakers. During study tendency of left ventricular mass/index reduction was detected. That become statistically significant (p<0,001) after 6-months of treatment (11,7/11,4%), consequently increased number of patients with concentric remodelling (from 18,7 to 25%) and normal geometry (from 12,5 to 18,7%), and decreased number of patients with concentric hypertrophy (from 31,3 to 25%) and eccentric hypertrophy (from 37,5 to 31,3%). Also there was significant (p<0,05) improvement of diastolic and endothelial functions (up to 28,7 and 45,5%, respectively) and increase of number of patients with normal endothelial function (from 25 to 53%). Data of laboratory tests revealed metabolic neutrality of Hartil. Thus, Hartil (5-10 mg daily) revealed high antihypertensive efficacy, metabolic neutrality and beneficial effects on cardiovascular remodeling process in old and elderly patients with isolated systolic hypertension, which contributes to reduce the risk of cardiovascular complications.