Background: Hypertensive heart disease is associated with a high incidence of diastolic heart failure, making evaluation of left ventricular (LV) diastolic function clinically important. The purpose of this study was to examine the diastolic paramerers using conventional Doppler imaging and those relations with left atrial (LA) volume when evaluating diastolic function in patients with hypertension. Subjects and Methods: We studied 522 patients with hypertension ranging in age from their 30’s to their 80’s (mean±SD, 61.8±14.7 years). Peak mitral flow velocity of the early rapid filling wave (E) and the late filling wave resulting from atrial contraction (A) were calculated by pulsed Doppler echocardiography; and early diastolic mitral annular velocity (e’), by tissue Doppler imaging. LA volume calculated from the apical two- and four-chamber views (biplane Simpson’s method) was corrected for body surface area and the LA volume index (LAVI) was calculated. The LV mass index (LVMI) was also calculated from LV mass analyzed using the American Society of Echocardiography (ASE) equation of the M-mode echocardiographic method or fault measurement. Patients with atrial fibrillation, ischemic heart disease, and moderate-to-severe mitral regurgitation were excluded. The two hundred eighty subjects comprising the control group had normal blood pressure and normal results on echocardiographic examination, including LV dimension and systolic function. Results: The LAVI of patients with hypertension showed no significant generational differences. Patients with hypertension were classified into two groups; HT-LAD (-) group: those with hypertension (LAVI<29ml/m2); HT-LAD (+) group: those with hypertension (LAVI>=29ml/m2). In most generations, diastolic dysfunction was more advanced in the hypertensive group than in the control group. In addition, e’ was lower and E/e’ higher in the HT-LAD (+) group than in the HT-LAD (-) group. Further, the correlation between E/e’ and LAVI (r=0.59, p<0.0001) and E/e’ and LVMI (r=0.59, p<0.0001) was significant. LV diastolic function in patients in their 30’s and 50’s with LA enlargement and hypertension is progressing about 20 years,suggested importance of antihypertensive management. Conclusion: LA volume measurement in patients with hypertension may prove useful in evaluating diastolic function more accurately.