Abstract: Objective To investigate apical morphology and dynamics of left ventricle in hypertensive patients with different left ventricular ejection fraction（LVEF） by two-dimensional and doppler echocardiography. Methods One hundred and twenty-eight essential hypertensive（EH） patients were divided into 3 groups according to LVEF: EH-A（LVEF＞65%）,EH-B（LVEF 50%-65%） and EH-C（LVEF＜50%）. Fifty-two healthy subjects without cardiovascular disease were recruited as normal control group（NC）. The apical angle(θ_AP), ratio of apical angle change(Δθ_AP-R), ejection velocity of apex(V_AP) were observed by two-dimensional and doppler echocardiography. Multivariate linear regression analysis was used to analyze the influencing factors of Δθ_AP-R. The receiver operating characteristic（ROC） curve was used to analyze the efficacy of indicators in judging LVEF reduction. Results Compared with NC group, left ventricular end-diastolic volume index（LVEDVI） and left ventricular mass index（LVMI） were increased in EH group（P＜0.05）. θ_AP decreased in EH-A, B and increased in EH-C（all P＜0.05）. Δθ_AP-R decreased gradually in EH-A, B and C EH-A（28.58±10.19）% vs EH-B（22.54±8.98）% vs EH-C（17.20±11.52）%, F=7.67, P＜0.05; V_AP increased in EH-A, B NC（0.23±0.06） vs EH-A（0.32±0.12） vs EH-B（0.28±0.07） m/s, F=8.16, P＜0.05. The multi-factor regression analysis showed that LVEDVI and LVEF were associated with Δθ_AP-R. ROC analysis for LVEF＜50% revealed that the area under the curve of θ_AP-d, θ_AP-s, Δθ_AP-R, V_AP, and Δθ_AP-R combined with V_AP was 0.858, 0.871, 0.736, 0.767 and 0.825, respectively. Conclusion The apical angle increased and the apical dynamics reduced gradually along with the LVEF decreasing in the progress of LVEF systolic dysfunction in hypertensive patients. The early enhancement of apical dynamics may contribute to the maintaining and preserving of LVEF. Δθ_AP-R can reflect the dynamic changes of left ventricle with different LVEF.