Introduction (relevance). Arterial hypertension (AH) remains one of the most pressing problems in medicine due to its high prevalence and key role in the structure of cardiovascular morbidity and mortality. In clinical practice, AH is extremely rare in isolation, acting as a central component of multiple comorbid conditions. The frequency of polymorbidity in individuals over 65 years reaches 98%, which creates a new pathophysiological quality with mutual aggravation of diseases and necessitates a paradigm shift in patient management. Purpose. To systematize and analyze current scientific data on the clinical and pathogenetic features of the comorbid course of AH in order to determine the patterns of its combination with various diseases and optimize approaches to patient management. Materials and methods. An analytical review of scientific literature was conducted using a systematic search methodology in international (PubMed, Google Scholar, Scopus) and national (eLIBRARY.RU, CyberLeninka) databases. The search covered publications mainly from 2021–2026, using keywords reflecting the comorbidity of AH with cardiovascular, endocrine, renal, gastroenterological, psycho-neurological, and other diseases. Results. It was found that the comorbidity index in individuals with AH is 16.8% higher than in those without it. The structure of concomitant pathology is dominated by diseases of the gastrointestinal tract (81.43%), the musculoskeletal system (77.14%), and the endocrine system (75.71%). Common pathophysiological mechanisms of syntropy were identified: chronic low-grade systemic inflammation, endothelial dysfunction, oxidative stress, and dysregulation of the renin-angiotensin-aldosterone system. The features of comorbidity of AH with coronary heart disease, chronic heart failure, atrial fibrillation, type 2 diabetes mellitus, chronic kidney disease, periodontitis, gastroesophageal reflux disease, anxiety-depressive disorders, and Alzheimer's disease are demonstrated. Comorbid pathology reduces the effectiveness of antihypertensive therapy and contributes to the formation of resistant forms of AH. Special attention is paid to the bidirectional iatrogenic effects of drugs. Discussion. Comorbidity in AH transforms the clinical picture and prognosis, requiring a personalized approach. The commonality of pathophysiological mechanisms justifies the need to choose drugs with organoprotective effects. An important aspect is the interdisciplinary interaction of specialists to correct combined pathology. The introduction of digital technologies for dynamic monitoring and increasing adherence to therapy seems promising. Conclusions (conclusion). In the vast majority of cases, arterial hypertension is the central link of complex comorbid clusters. The key mechanisms of mutual aggravation are chronic inflammation, endothelial dysfunction, and RAAS dysregulation. The management of comorbid patients requires an integrative, interdisciplinary approach aimed at managing health as a whole, which will improve the long-term prognosis and quality of life for this category of patients.