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Background: Decreased left atrial (LA) function is associated with atrial arrhythmia in hypertension. However, effects of left ventricular (LV) geometry on LA strain and strain rate were not well studied.Methods: This study recruited 63 patients (mean age 57 ± 12 years, 34 men) with uncomplicated untreated hypertension and 21 age- and sex-matched normal subjects as control (NM). Hypertension subjects were further divided into 4 groups based on LV geometry including normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Two-dimensional images obtained from apical 4-chamber and 2-chamber views were used for speckle tracking echocardiography analysis of LA. Peak positive strain (LASp) and peak negative strain (LASn) after P-wave were measured from the strain curve. Positive filling strain rate (LASRf), peak negative conduit strain rate (LASRc), and peak negative atrial strain rate (LASRa) after P-wave were measured from the strain rate curve.Results: Among hypertensive patients, there were 29 patients with NG, 16 CR, 8 CH, and 10 EH. In comparison between NM and NG, LA volume index increased significantly in NG group (20 ± 5 vs. 24 ± 7 ml/m2, p = 0.022) but no differences in strain and strain rate. In comparison between NG and CR, there were no difference in neither LA volume index nor strain and strain rate. In comparison between NG and CH, LASRc was significantly decreased in CH group (-2.21 ± 0.51 vs. -1.71 ± 0.40 1/s, p = 0.019). In comparison between NG and EH, LASRc (-2.21 ± 0.51 vs. -1.72 ± 0.33 1/s, p = 0.010) and LASRa (-3.13 ± 0.61 vs. -2.58 ± 0.31 1/s, p = 0.009) were significantly decreased in EH. Only LASRc was stepwise decreased from NM, NG, CR, CH, to EH (p = 0.001 by ANOVA). Mitral early velocity to average annulus early velocity ratio (E/e') was significantly correlated with LASp (r = -0.391, p <0.001), LASn (r = 0.227, p = 0.040), and LASRc (r = 0.498, p <0.001).Conclusions: In hypertension heart disease, LA volume increased at first when LV still in normal geometry. LA strain rate decreased when LV hypertrophy presented either concentric or eccentric. LV strain and strain rate were significantly correlated with LV filling pressure represented by E/e'.