Objective: To explore the effect of Ramipril on renin-angiotensin-aldosterone system of young and middle-aged patients with hypertension. Methods 90 young and middle-aged patients with hypertension who had been seeking treatment in the hospital between August 2017 and August 2018 were selected and randomly divided into a control group and an observation group according to the random number table, with 45 cases in each group. The control group received Amlodipine for treatment, whereas the observation group was given Amlodipine combined with Ramipril for treatment. The hemodynamic indexes, blood lipid, blood pressure, angiotensin Ⅱ (Ang Ⅱ), plasma renin (PRA), aldosterone (ALD) levels and incidence of adverse reactions during the medication in the two groups were compared before and after treatment. Results After treatment, thefibrinogen, plasma viscosity and whole blood viscosity in the observation group were significantly higher than those in the control group, with statistically significant difference between the two groups (P<0.05); total cholesterol (TC), triacylglycerol (TG) and low density lipoprotein cholesterin (LDL-C) in the observation group were significantly lower than those in the control group, and statistically significant difference was registered between the two groups (P<0.05); the diastolic pressure and systolic pressure in the observation group were decreased more significantly compared with the control group, with statistically significant difference shown between the two groups (P<0.05); the Ang Ⅱ, ALD and PRA levels in the observation group were significantly lower than the control group, and the difference between two groups were statistically significant (P<0.05); during the medication, no significant bleeding or liver and kidney function damages occurred in the two groups. Conclusions For young and middle-aged patients with hypertension, the treatment with Ramipril, which is of high safety, can effectively improve the activity of their renin-angiotensin-aldosterone system, reduce the level of blood pressure and Ang Ⅱ, ALD and PRA levels.