Abstract: Objective To evaluate the left atrial strain in essential hypertension（EH） patients with normal left ventricular configuration by two-dimensional speckle tracking imaging（2 D-STI） and to analyze the relationship between the left atrial strain and the number of positive indicators of left ventricular diastolic dysfunction（LVDD）. MethodsA total of 100 EH patients with normal left ventricular configuration admitted to the First Hospital of Shanxi Medical University from January 2019 to July 2020 were selected, and 120 healthy patients were selected as the control group. Left atrial end systolic diameter（LAD）, left ventricular end diastolic diameter（LVEDD）, interventricular septal thickness（IVST）, left ventricular posterior wall thickness（LVPWT）, early diastolic transmitral inflow veloticy（E） and late diastolic mitral valve flow velocity（A）, E peak deceleration time（DT）, isovolumic relaxation time（IVRT）, lateral/septal mitral annular velocity（e’）, maximal tricuspid regurgitation velocity(TRV_max), left ventricular ejection fraction（LVEF）, relative ventricular wall thickness（RWT）, E/A, E/e’, left atrial volume index（LAVI） and left ventricular mass index（LVMI） in EH group and control group were measured. According to 2016 American Society of Echocardiography（ASE）/European Association of Cardiovascular Imaging（EACVI） guidelines: interval e’＜7 cm/s or lateral wall e’＜10 cm/s, E/e’＞14, LAVI＞34 mL/m~2,TRV_max＞2.8 m/s, 100 patients with EH were divided into normal diastolic function, uncertain diastolic function and diastolic dysfunction. The patients with normal diastolic function and uncertain diastolic function were divided into 0, 1, 2 LVDD index positive groups. 2 D-STI technology was used to obtain left atrial longitudinal strain curves of the two groups, including left atrial reserve strain（LASs）, left atrial conduit strain（LASe） and left atrial contractile strain（LASa）. The basic data, conventional ultrasonic parameters and left atrial strain values between EH group and control group were analyzed, and the relationship between LASs, LASe, LASa and the number of positive indicators of LVDD was analyzed. Results Compared with the control group, systolic blood pressure, diastolic blood pressure, E/e’, LAVI and LAD in EH group were higher, but ventricular septum e’, left ventricular side wall e’, LASs and LASe were lower, and the difference was statistically significant（P＜0.05）. In EH group, LASs（r=-0.512） and LASe（r=-0.378） were negatively correlated with E/e’（all P＜0.05）. Multivariate logistic regression analysis showed that LASs and LASe were independently correlated with the number of positive indicators of LVDD before the occurrence of LVDD, and the difference were statistically significant（B=-0.23,-0.36, P＜0.05）. Compared with 0 positive index groups, LASs and LASe in 1, 2 and 3 or 4 LVDD positive index groups decreased with statistical significance LASs:（32.27±4.59）%,（25.70±3.80）%,（21.80±2.32）% vs（39.45±3.82）%, F=40.231, P＜0.001; LASe:（16.28±2.81）%,（13.66±2.99）%,（10.30±1.49）% vs（22.01±3.49）%; F=35.681, P＜0.001. There were no significant difference in LASa among 0, 1, 2 and 3 or 4 LVDD positive index groups（P＞0.05）. Conclusions Left atrial function has been changed before the diagnosis of LVDD in patients with EH. The application of 2 D-STI to measure left atrial strain indicators LASs and LASe can effectively evaluate the early diastolic function changes in EH patients.