Obesity is one of the main causes of increased blood pressure, and its combination with irritable bowel syndrome with constipation contributes to its higher rates and unfavorable daily profits. The multifactorial nature of pathogenesis and the inability to identify the leading mechanisms for its development require the search for new combinations of antihypertensive drugs. The aim of the study – to investigate the efficacy of α1-adrenergic blocker (urapidil) on daily blood pressure, lipid profile and serotonin levels in patients with this comorbidity. Materials and Methods We examined 89 patients with obesity, arterial hypertension and irritable bowel syndrome with constipation, divided into 4 groups depending on the combination of antihypertensive drugs. Results and Discussion The most pronounced therapeutic effect was established following the administration of urapidil 30 mg twice a day, which was manifested by the most significant reduction in daily systolic and diastolic blood pressure, left ventricular myocardial mass, terminal systolic and diastolic volume, and increased ejection fraction compared with Patients receiving the angiotensin converting enzyme inhibitor, calcium channel blockers and thiazide diuretic in combination with statins and patients who received vita-melatonin 3 mg per before sleeping in addition to this therapy. Conclusions After a course antihypertensive therapy with urapidil, the lipidograms improved significantly, the frequency of defecation increased, and serotonin levels in the blood close to normal values.