OBJECTIVE: To evaluate the myocardial perfusion in hypertensive patients with and without left ventricular hypertrophy using thallium-201 (201TI) myocardial scintigraphy and explore the mechanism that causes the perfusion abnormalities. METHODS: Thallium-201 myocardial scintigraphy was performed in 85 patients with clinically suspected coronary artery disease to assess the myocardial perfusion status. For patients with myocardial perfusion abnormalities as indicated by the scintigraphy, coronary angiography was ordered within 1 month. RESULTS: The incidence of 201TI myocardial perfusion abnormalities in hypertensive patients with ventricular hypertrophy (85.7%) was significantly higher than that in the normotensive (39.3%, P<0.01) and hypertensive patients not complicated with hypertrophy (61.2%, P<0.05). The semiquantitative score was higher in the hypertensive patients with hypertrophy than in the normotensive (P<0.01) and hypertensive patients without hypertrophy (P<0.05). More hypertensive patients with hypertrophy (9/18) had normal results of coronary angiography than the normotensive (0/13, P=0.044) and hypertensive patients without hypertrophy did (3/19, P<0.05). CONCLUSIONS: A higher rate of 201TI perfusion abnormalities occurs in the hypertensive patients with ventricular hypertrophy, which may be attributed to the pathological changes in the major coronary vessels and to the coronary microvascular diseases as well.