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Background: Young hypertensive(HT) patients tend to neglect the importance of managing blood pressure(BP) as left ventricular(LV) morphology remains normal and no signs of end organ damage are found. Recently, the impairment of cardiac function can be detected before apparent LV structural changes by 2-dimensional speckle tracking imaging(2DS). Our aims were to assess LV functional changes in relation to the ambulatory BP in young adults with never treated HT and no LV hypertrophy.Methods: Consecutive 40 young patients(30±6 years) with first diagnosed primary HT and 40 normal controls(29±5years) were enrolled. Patients with coronary artery disease, diabetes, LVEF<50%, LV hypertrophy(by 05 ASE guideline), and Cr>1.5mg/dL were excluded. 2DS was performed and LV global longitudinal, radial, and circumferential peak strain(GLS, GRS and GCS, respectively) and twist were obtained. Ambulatory BP monitoring was performed in all HT patients. A standard deviation of daytime and nighttime BP below or above the median was considered at low or high BP variability.Results: There was no difference of LV size, EF and mass index between HT patients and controls. LV GLS was lower and twist was higher in HT patients than in controls, however, there was no difference of GRS and GCS. Patients with high daytime diastolic BP showed lower GLS and higher twist than patients with low daytime diastolic BP. Moreover, patients with high daytime diastolic BP variability showed lower GLS and higher twist than patients with low daytime diastolic BP variability.(Table)Conclusion: Early changes of LV function with decreased GLS and increased twist were shown in young HT patients. High daytime diastolic BP and its variability were most related to the impairment of LV function, which may be related to increase in afterload and subendocardial damage even in no LV hypertrophy.