Hypertension is a leading non-communicable disease in Nigeria with prevalence rates of 9.8% and 14.6% in rural and urban areas respectively. The goal of antihypertensive therapy includes adequate BP control, reduction of cardiovascular risks, improving quality of life and prevention or reversal of LVH. Although the effects of calcium channel blockers and ACE inhibitors on LV structure and functions have been extensively studied in the Caucasian population, it is yet to be evaluated in the Nigerian population of patients with hypertension. Similarly, there is relative paucity of published works on use of ACE inhibitors in Nigerian patients. This study intended to add to the available information on use of felodipine and ramipril in BP control and determine possible short term effects of these agents on LV geometry and functions of Nigerian patients with mild to moderate hypertension. Aims and Objectives The aim of the study included comparing the degree of blood pressure reduction with felodipine and ramipril after 12 weeks of follow up, comparing their relative tolerability and safely and their effects on LV geometry and function. Methodology Sixty patients with mild to moderate hypertension were randomized to 12 weeks of treatment with either felodipine ER or ramipril making a total of 30 patients per treatment group. The study design was a four phase stepped care trial of 3 weeks interval each. Each agent was started at a dose of 5mg daily and then adjusted upwards with addition of HCT at subsequent phases as guided by BP responses. Baseline echocardiography, heamatological and biochemical tests were carried out and repeated at the end of 12 weeks of treatment. Adverse effects monitoring was done using a structured questionnaire coupled with patients’ complaints at each visit. Results Felodipine monotherapy was found to be effective in lowering BP. 88% of patients treated with felodipine achieved adequate BP control on felodipine monotherapy. In contrast, there was a poor response to ramipril monotherapy with 92% of patients treated with ramipril requiring addition of HCT to achieve adequate BP control. Both study groups recorded significant systolic and diastolic BP reductions at the end of 12 weeks of follow up and there was no difference in the means of changes in BP observed in the two groups. The two drugs produced no significant changes in the LV mass and systolic functions of the study patients at the end of 12 weeks. Both drugs were safe and well tolerated. Conclusion Felodipine monotherapy is a more effective agent in BP control than ramipril. Ramipril is well tolerated at high doses by Nigerian hypertensive patients if carefully titrated over an appropriate time period. There is a need for a similar study involving larger population of patients and lasting for longer duratio