OBJECTIVE Electrocardiographic (ECG) ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy and/or ischaemia and a higher cardiovascular risk. Hypertensive patients with typical or non-typical chest discomfort and a normal coronarographic study underwent an echocardiographic and Doppler study in order to assess left ventricular structure and (systolic and diastolic) function. METHODS Hypertensive patients with ST-T changes were classified as follows: Control group (CG) was made up of 12 hypertensive patients (6 women, 6 men, mean age 59.6 +/- 7.4 years) with normal ECG; Group A (GA), 10 patients (6 women, 4 men, mean age 63.1 +/- 6.8 years) with ECG image of strain; Group B (GB) (9 women and 8 men, mean age 61.3 +/- 10.1 years) with other ST-T alterations. We assessed by echocardiographic and transmitral flow Doppler study left ventricular structure and (systolic and diastolic) function. RESULTS Interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and mass index were significantly higher in the GA and GB than in the CG, without differences between GA and GB groups. No differences in left ventricular systolic function parameters were observed between the groups. In comparison with the CG, the GA and GB showed significant differences in E wave deceleration velocity and deceleration time, A wave deceleration time and isovolumetric relaxation time. Between GA and GB differences were observed in A wave deceleration time and isovolumetric relaxation time. CONCLUSIONS In hypertensive patients without atherosclerotic coronaropathy, ST-T changes identify a group with greater left ventricular mass and worse left ventricular diastolic function. The patients with a ST-T strain pattern showed the impaired diastolic function.