Purpose <p>Left ventricular mechanical dyssynchrony (LVMD) is recognised as a contributing factor to LV dysfunction in hypertensive patients. However, limited studies have examined whether LVMD in hypertensive patients predates the development of left ventricular hypertrophy (LVH).</p> Methods <p>This study analysed data from 121 hypertensive patients with normal left ventricular ejection fraction (LVEF) and gated myocardial perfusion SPECT (GMPS), divided into two sub-groups: those with LVH (<i>n</i> = 50) and those without LVH (<i>n</i> = 71). The control group included 87 normotensive patients with normal LVEF and GMPS. Software-derived phase analysis parameters were compared across groups, and the effects of hypertension and LVH on LVMD were assessed using regression analysis.</p> Results <p>The case group (hypertensive) exhibited a higher prevalence of LVMD (33.8%) compared to the control group (18.4%) (<i>p</i> &lt; 0.05). Within the case group, the LVH subgroup had a higher prevalence of LVMD (48%) than the non-LVH subgroup (24.3%) (<i>p</i> &lt; 0.05) and the control group (<i>p</i> &lt; 0.05). No significant difference was found in the frequency of LVMD among the non-LVH subgroup and the control group (<i>p</i> &gt; 0.05). The LVH subgroup also had a greater mean phase bandwidth (PBW) than both the control and non-LVH subgroups, with no significant difference between the latter two. The multivariate analysis for PBW accounted for 17.2% (adjusted R²) of the variance, revealing a significant association with LVH, while hypertension showed no significant relationship.</p> Conclusion <p>LVMD in hypertensive patients is associated with the presence of LVH. The incidence of LVMD among hypertensive patients without LVH is comparable to that in the normotensive population.</p>