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We investigated left atrial (LA) function in relation to hypertension using 2-dimensional speckle-tracking echocardiography (STE) in subjects with preserved left ventricular (LV) ejection fraction, while accounting for LA enlargement and LV mass and diastolic function.We performed standard 2-dimensional and Doppler echocardiography and LA volumetric measurements and STE strain imaging in hypertensive patients (systolic/diastolic blood pressure ≥140/90 mmHg, or use of antihypertensive drugs, n = 124) and age- and sex-matched normotensive subjects (n = 124). We measured the peak LA velocity, strain, and strain rate during systole and early and late diastole, respectively. We investigated the associations of interests in the presence or absence of LA enlargement (LA volume index ≥28 mL/m2).Hypertensive and normotensive subjects had similar LV ejection fraction and LA diameter (P ≥ 0.22). However, hypertensive compared with normotensive subjects had enlarged LV and impaired diastolic function, and had increased LA volumetric measurements and decreased LA emptying fractions (P < 0.0001). Hypertensive patients also had impaired LA function, as measured by STE velocity, strain, and strain rate in general and in the absence of LA enlargement (P < 0.0001). The differences in LA STE strain rate during LV systole and LA contraction between hypertension and normotension in the absence of LA enlargement remained statistically significant (P < 0.001), after adjustment for age, sex, and LV mass index and E/E’.Hypertension is associated with impaired LA function, as assessed by STE strain imaging technique, even before LA enlargement develops and after LV remodeling is accounted for.