Aim: To study heart and vascular remodeling in essential hypertension (EH) and concomitant type 2 diabetes mellitus (DM2) with respect to genetic polymorphism of the angiotensin II receptor type 1 (AGTR1) gene and peroxisome proliferator-activated receptor-γ2 (PPARγ2). Methods: Biochemical blood analysis, echocardiographic evaluation of mitral diastolic blood flow and tissue Doppler spectral modes, reactive hyperemia, color Doppler mapping. Results: Patients with A/C and C/C genotypes of the AGTR1 gene had higher blood pressure, more pronounced metabolic disorders, a larger left ventricle (LV), higher myocardial mass index left ventricle, and a greater intima media thickness (IMT), with a lower rate of endothelium-dependent vasodilation (EDVD) compared to the A/A genotype. Patients with... the Pro/Pro genotype of PPARγ2 had higher levels of blood pressure, larger LVs, greater IMT, pulse wave velocity, and a lower rate of EDVD compared to the Pro/Ala and Ala/Ala genotypes. Patients with the Pro/Pro genotype had significantly more pronounced dyslipidemia and insulin resistance than patients with other PPARγ2 genotypes. Conclusion: The polymorphism of genetic markers AGTR1 and PPARγ2 in patients with EH and concomitant DM2 was associated with the development of comorbidity. Different genotypes of specific genes alter the severity of cardiovascular remodeling and metabolic disorders.