Background:Diastolic dysfunction, a precursor to heart failure often underestimated in hypertensive patients, warrants early detection and management to mitigate cardiovascular morbidity and mortality. Previous studies primarily relied on the transmitral low-velocity curve, which has limitations, especially in cases with a pseudo normal pattern. This study combines transmitral flow velocity curves and pulmonary venous Doppler analysis to assess diastolic function in hypertensive individuals with preserved left ventricular systolic function to estimate the prevalence of diastolic dysfunction among hypertensive patients. Methods:This study was conducted at Government Sivagangai Medical College, South India, during September and October 2021 among 150 hypertensive patients from the non-communicable disease clinic. Patients with certain cardiac complications, diabetes, alcoholism, cirrhosis, chronic kidney disease, or an ejection fraction below 50% were excluded. Diastolic function was assessed using transmitral flow velocity curves, employing an E/A ratio cut-off value of1.0. Pseudo normal patterns were identified via ∆d fraction analysis, while ECG findings were also evaluated.Result:In this study, 43% of participants exhibited abnormal E/A ratios indicative of diastolic dysfunction. Subsequent ∆d fraction analysis identified a subset of patients with a pseudo normal pattern, resulting in 62% of patients having diastolic dysfunction. ECG findings revealed left atrial enlargement (38%), left ventricular hypertrophy (33%), and left axis deviation (24%) as common abnormalities. Correlations emerged between diastolic dysfunction and age, sex, duration of hypertension, systolic/diastolic blood pressure, and ECG abnormalities.Conclusion:This study underscores the underrecognized prevalence of diastolic dysfunction among hypertensive patients without clinical heart disease. Combining transmitral flow velocity curves and ∆d fraction analysis improves diagnostic accuracy, particularly in pseudo normal patterns. ECG findings emphasize diverse cardiac manifestations linked to hypertension. Comprehensive cardiovascular assessments in hypertensive patient management are crucial. Early detection and management can mitigate cardiovascular risks, necessitating further research into underlying mechanisms and risk factors.