Objective: In hypertensive patients the presence of left ventricular hypertrophy (LVH) is associated with increased cardiovascular (CV) morbidity and mortality. Unfortunately electrocardiogram (ECG) has a low sensitivity in detecting LVH, while echocardiography cannot be routinely and extensively performed in all hypertensive patients. In this study we evaluated the prevalence of LVH and of anomalies of diastolic function in a group of hypertensive patients with normal ECG, and free of diabetes and CV diseases. Design and Methods: Patients with CV diseases, diabetes, chronic kidney disease (CKD), electrocardiographic LVH (Sokolow-Lyons or Cornell criterion) or “strain” were excluded. We enrolled 196 middle-aged hypertensive patients (M/F: 124/72). All the enrolled subjects underwent an echocardiographic examination (Acuson Sequoia 512). Left ventricular mass (LVM) was indexed by body surface area (LVMI) and by height2.7 (LVMH2.7). LVH was defined as LVMI >125g/m2 in men and >110 g/m2 in women, or as LVMH2.7 >51 g/m2.7 in both sexes. Diastolic function was principally assessed by Tissue Doppler Imaging (TDI). Results: With regard to LVMI, 20/196 patients (10.2%) had LVH (2 eccentric and e 18 concentric, 12 women and 8 men). In this subgroup of 20 subjects, the value of LVMI had a percentage difference from the cut-off value for LVH of 15.1 ± 11.4%. Among the 196 patients, only 6 out of the 20 with LVH had diastolic dysfunction, defined as early diastolic myocardial velocity (Em) <0.08 m/s. Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, free of diabetes and of CV diseases is low; moreover, patients with echocardiographic LVH presented LVMI values that identified mild LVH. Few cases of impaired diastolic function were registered. We suggest that in hypertensive patients with such characteristics the echocardiographic examination should be reserved to those who present with higher duration of hypertension.