Abstract: Objective To investigate the systolic synchrony of the left ventricle in patients with hypertension,hypertensive left ventricular hypertrophy,heart failure and preserved ejection fraction（HF-pEF）induced by hypertension respectively and to analyze the influencing factors of left ventricular systolic asynchrony in HF-pEF patients.Methods During June 2011 to May 2014,a total of 352 cases with essential hypertension（EH）were enrolled in this retrospective study,which consisted of 160 males and 192 females with average age of（67.6±7.8）years old.All cases were divided into hypertension group（n=182）,left ventricular hypertrophy group（LVH,n=74）and HF-pEF group（n=96）according to the corresponding diagnostic criterions. Ultrasonic and gated myocardial perfusion imaging（G-MPI）were performed for the assessment of left ventricular remodeling and systolic synchrony.Cardiac structure and function parameters,left ventricular mass index（LVMI）,phase histogram bandwidth（PHB）,phase standard deviation（PSD）and serum brain natriuretic peptide values were compared among groups.Patients within HF-pEF group were further divided into 4 groups in terms of different quartiles of PHB and PSD.Multivariable linear regression was used to analyze the influencing factors of PHB and PSD. Results Compared with hypertension group,the LVMI increased（121.1±9.8）,（123.2±10.9）vs（94.4±10.1）g/m~2,P＜0.05and E/A decreased（0.80±0.28,0.67±0.17 vs 1.19±0.23,P＜0.05）in LVH and HF-pEF groups. No significant difference was detected in left ventricular ejection fraction（LVEF）among 3 groups（F=2.89,P＞0.05）. Dramatic left ventricular systolic asynchrony occurred in HF-pEF group:PHB （88.4±8.6）°vs（33.3±7.7）°,（52.2±6.9）°and PSD （23.6±1.9）°vs（9.2±2.1）°,（16.3±1.6）°were higher than hypertension and LVH groups（all P＜0.01）. Serum brain natriuretic peptide level in HF-pEF group was higher than LVH group（228.4±69.7）vs（92.5±13.6）ng/L,P＜0.01. The differences of age,hypertension course,left atrial diameter（LAD）,LVEF,LVMI,E/A and QRS durations were significant among PHB and PSD quartiles（all P＜0.05）.Multiple linear regression analysis showed that LVMI and QRS duration were influencing factors of systolic asynchrony of left ventricles within HF-pEF group（B=0.711 and 0.164 when PHB as dependent variable;B=0.159 and 0.048 when PSD as dependent variable,respectively,all P＜0.01）. Conclusion The patients of HF-pEF induced by essential hypertension are characterized with typical left ventricular systolic asynchrony,which may be related to increased LVMI and prolonged QRS duration.