Essential hypertension is characterized by parallel and potentially reversible vascular and cardiac adaptations. In our study, Capillaroscopy, echocardiography, and 24-h ambulatory blood pressure profiles were performed in 17 patients (aged 33–63 years: mean, 52 years) with mild-to-moderate hypertension. We measured morphological and hemodynamic parameters of capillary microcirculation as well as morphological echocardiographic parameters at baseline and after 6 weeks' treatment with 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide. Digital capillary blood flow measurements were assessed by nail fold video Capillaroscopy. After 6 weeks of treatment with cilazapril plus hydrochlorothiazide, mean diastolic 24-h ambulatory blood pressure decreased from 98 ± 6 to 85 ± 7 mm Hg. Capillary blood cell velocity was 0.6 ± 0.4 mm/s at baseline and increased to 0.6 ± 0.4 mm/s. There were no significant changes in morphological capillaroscopic and echocardiographic parameters. In conclusion, we observed a trend toward higher capillary blood cell velocity as early as after 6 weeks of treatment with cilazapril plus hydrochlorothiazide in mild-to-moderate hypertension.