AIM: To assess effect of combined antihypertensive and lipid lowering therapy on main characteristics of metabolic syndrome and total coronary risk. MATERIAL: Seventy five patients with metabolic syndrome aged 40-59 years were included into an open study with parallel groups in which the following combinations of lipid lowering and antihypertensive drugs were used for sweeksinch: atorvastatin + perindopril (n=17, group 1); simvastatin + atenolol (n=17, group 2); fenofibrate + atenolol (n=21, group 3), and simvastatin + indapamide (n=20, group 4). Systolic and diastolic blood pressures (BP), blood serum concentrations of total cholesterol (CH), low density lipoprotein (LDL) and high density lipoprotein (HDL) CH, glucose and immunoreactive insulin were measured before and after treatment. Total coronary risk was calculated according to the PROCAM model. RESULTS: Treatment was associated with decreases of systolic and diastolic BP (from 11% in group 1 to 18,4% in group 2), lowering of total CH (by one third in groups 1 and 2, by 20% in groups 3 and 4), and triglycerides (by 2 times in group 3 and by 7-21% in other groups). Increases of HDL CH were observed in groups 2-4. There were no significant changes of markers of insulin resistance. Baseline total coronary risk was high (37%). Treatment was accompanied with lowering of total risk by 57.4-70%. CONCLUSION: Combined antihypertensive and lipid lowering therapy leads to pronounced lowering of high coronary risk in metabolic syndrome.