Efficacy of combined antihypertensive and metabolic therapy in correction of vasodilation disturbances and metabolic stability of endotheliocytes was studied in 42 patients with refractory arterial hypertension(AH). Patients from group 1 received amlodipine 5 mg, lisinopril 10 mg, indapamide 2.5 mg and combined metabolic drug kudesan forte (coenzyme Q10 30 mg + vitamin Е 4.5 mg). Patients form the group 2 received the same therapy except kudesan. Metabolic stability of vascular endothelium was investigated using vascular probe with methacholine and additional administration of ascorbic acid. It is shown that patients with refractory AH addition of metabolic therapy to antihypertensive treatment provides supplementary therapeutic effect including marked increase of nitrate/nitrite levels in plasma after 12-week treatment, normalization of vasodilative reactions during methacholine stimulation and occlusion probe, increased metabolic stability to oxidative stress. It is drawn a conclusion that metabolic therapy provides organ-protective vascular effect in treatment of refractory AH.