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Purpose: To test the capability of real time 3-D echocardiography parameters in characterizing early abnormalities of left ventricular (LV) structure and function in young patients with uncomplicated arterial hypertension.Methods: 23 newly diagnosed, never treated young hypertensives (H) (2 women, age = 30 ± 9 years) and 30 healthy young controls (C) (3 women, age = 28 ± 5 years) underwent real-time 3-D echocardiographic assessment of LV structure and function. Attention was provided to obtain a frame rate of at least 40% of the individual heart beating during the full volume recording. For this reason, consecutive 4-beat ECG-gated subvolumes were acquired during apnea (multibeat acquisition) to generate the full-volume. Care was also taken to encompass the entire LV cavity and wall in the data set. LV volumes and ejection fraction, sphericity index, LV mass index, global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were determined off-line.Results: The 2 groups were comparable for heart rate while body mass index, systolic, diastolic and mean blood pressure were higher in H (all p<0.0001). LV end-diastolic volume, LV end-systolic volume, ejection fraction and sphericity index did not differ significantly between the 2 groups. LV mass index was higher in H (73 ± 7 g/m2) than in C (67 ± 6 g/m2) (p<0.01). GLS (−19 ± 2% in H and -21 ± 3% in C, p<0.005), GAS (-30 ± 3% vs. -33 ± 4%, p<0.0002) and GRS (49 ± 8% vs. 53 ± 9%, p<0.01) were lower in H while GCS was similar between the 2 groups (-16 ± 2% in H and -17 ± 2%, NS). In the overall population GAS was related negatively with mean blood pressure (r = −0.49, p<0.0001), body mass index (r = −0.30, p<0.01), LV end-systolic volume (r = − 038, p<0.005) and LV mass index (r = −0.35, p<0.01) and positively with ejection fraction (r = 0.45, p<0.001) and sphericity index (r = 0.29, p<0.02).Conclusions: Real time 3-D echocardiography allows to characterize early changes of LV structure and function in young hypertensive patients. Global longitudinal and radial strain are both compromised while circumferential strain seems to be preserved. Global area strain appears as a novel and important parameter which is early modified in the hypertensive heart. It is very sensitive to pressure overload, but also to overweight and LV mass increase and represents an accurate estimate of LV global systolic function.