Background The study aims to analyze the effect of three types of treatment on functional status, and cardiovascular risk outcomes in hypertensive older adults with comorbidities. Methods Participants (n =418) underwent one of the following 3 conditions: i) multicomponent exercise training 3 times/week (MEX; n =116); ii) angiotensin converting enzyme inhibitors used mono-dose daily (ACEi; n =70); iii) combined exercise and ACEi drugs (ACEiMEX; n =232). The trial was completed by 82% of the participants (n =342): MEX (n =90); ACEi (n =66); ACEiMEX (n =186). Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, Short Form Health Survey 36 (SF-36), the health history questionnaires, anthropometric and hemodynamic profile. Results MEX and ACEiMEX groups improved all physical functional status outcomes, decreased systolic (SBP) and diastolic blood pressure (p <0.001) and augmented the physical functioning, role physical and physical component score (PCS) (p <0.05), but also bodily pain (p <0.05). The ACEi group reduced the upper body strength, upper and lower body flexibility and aerobic endurance (p <0.05); worsened the anthropometric profile, and SBP (p <0.001); and decreased general health and PCS (p <0.05). Conclusions The improvement of the physical functioning and HRQoL in older hypertensive adults using ACEi medications only occur if they adopt an exercise training regimen, increasing also the management of the blood pressure and other cardiovascular risk factors.