Aim: to establish the features of the blood lipid profile in patients with arterial hypertension with obesity depending on the level of physical activity. Object and methods of the study. The study included 124 men with essential hypertension stage II with overweight or obesity, average age 43.7 (10.7) years, with average duration of hypertension is 6.08 (7.87) years. Patients were divided into three groups, depending on the level of physical activity in the anamnesis and at the time of examination. Group 1 included 40 (32.3%) men with an average age of 46.6 (12.4) years, who had been involved in sports in the past and currently have regular physical activity. Group 2 included 54 (43.5%) men with a mean age of 43.0 (9.8) years who had only exercised in the past, group 3 consisted of 30 (24.2%) men with a mean age of 41.1 (8.9) years who had not previously and currently do not have regular physical activity. All patients underwent clinical, laboratory and instrumental examinations according to the evidence-based clinical guideline «Arterial Hypertension» 2024. Results. When stratifying cardiovascular risk according to the SCORE2 scale, it was found that all those examined, regardless of physical activity, correspond to the very high risk category. A factorial analysis of variance (ANOVA) was performed to quantify the degree of influence of physical activity, body mass index separately and their combined influence on changes in lipid profile. It was demonstrated that a decrease in the intensity of physical activity mainly affects the decrease in high-density lipoprotein cholesterol. Also an increase in body weight significantly affects the increase in triglyceride levels. The degree of total influence of a decrease in physical activity with an increase in body mass index on the deterioration of lipid profile characteristics significantly increased. Conclusion. The results obtained indicate a special role of the influence of increased body mass index and physical inactivity on pathological changes in the blood lipid profile in patients with hypertension and obesity depending on physical activity. According to the results of multifactorial analysis of variance (Factorial ANOVA) with a high level of probability, physical activity is associated with an increase in HDL-C — as an «anti-atherosclerotic» component of the lipid profile, while an increase in BMI significantly influenced the increase in triglyceride levels, which has a «pro-atherosclerotic» effect.