Background. Changes in the autonomic nervous system (ANS) in arterial hypertension (AH), comorbid with overweight and obesity, have not been finally established, and only in a few studies, the parameters of heart rate variability (HRV) have been compared with indicators of the composite human body structure.
Objective. Evaluation of the parameters of HRV associated with gender and indicators of composite body structure in middle-aged hypertensive people to determine methods of prevention and treatment of AH.
Methods. 35 men and 59 women with AH aged 45 to 59 years were examined. Questioning, anthropometry with determination of body mass index (BMI) and composite body structure by bioimpedancemetry, as well as measurement of blood pressure (BP) and monitoring of HRV using short (ten-minute) records were carried out.
Results. Overweight and obesity were detected in 87.1% of middle-aged people with AH. A direct correlation of visceral fat (VF) with age, as well as with diastolic BP, was observed in patients of both sexes. In women, compared with men, parasympathetic activity and the autonomous circuit of HRV regulation prevailed. With overweight and obesity, a higher index of tension in the regulation of the heart rhythm and a more pronounced sympathetic activity of the ANS in terms of the LF/HF parameter were determined. A lower total HRV, low parasympathetic activity of the ANS, and tension in the regulation of the heart rhythm with the involvement of the central circuit in persons with AH were found not only at high, but also at intermediate values of VF.
Conclusion. Detection of AH, elevated BMI, VF and associated HRV indicators is necessary for diagnosing autonomic imbalance in
middle-aged people to monitor the effectiveness of non-drug and drug therapy for AH.

Keywords: short electrocardiogram recordings, middle age, visceral fat, overweight, heart rate variability, arterial hypertension