Objectives: This study aimed to compare the effect of benidipine and losartan on central blood pressure (BP) and arterial stiffness in mild to moderate essential hypertensives. Methods and Results: This 24 weeks, multi-center, open label, randomized, active drug comparative, parallel group study was designed as a noninferior study. Eligible patients (n=200) were randomly assigned to receive benidipine (n=101) or losartan (n=99). Radial artery applanation tonomery and pulse wave analysis were used to derive central BP, pulse wave velocity (PWV) and augmentation index (AIx). Additionally we measured the serum levels of hs-CRP, adiponectine, hs-RAGE, osteoprotegrein and PIP and calculated HOMA index. No significant differences were found in the mean changes in central BP between 2 groups [-16.66 (systolic BP)/-10.70 (diastolic BP) mmHg in the benidipine group and –18.44/-11.79 mmHg in the losartan group; P=NS]. The mean changes in central aortic PWV and AIx were –0.06 m/esc and –5.46% for the benidipine group and -0.02 m/sec and –4.22% for losartan group (respectively; p=NS). There were no differences between two groups in the serum levels of metabolic and inflammatory markers. Conclusion: The reduction in central BP after 24 weeks of benidipine was non-inferior to that of losartan in mild to moderate essential hypertensives. There were no significant different between 2 drugs in aspect of peripheral BP, arterial stiffness and metabolic and inflammatory markers. So benidipine was as effective as losartan in lowering central and peripheral BP and affecting arterial stiffness. Furthermore benidipine might have similar metabolic and inflammatory modulatory effects to losartan.