Hypertension (HTN) is a heterogeneous disease with both well-stablished and unknown causes. HTN is a major madifiable risk factor for stroke and various cardiovascular disorders. It is associated with significant morbidity and mortality rates. The key role of echocardiography in risk assessment hypertension is the evaluation of left ventricular hypertrophy (LVH) and left ventricular mass (LVM). Indeed, LVH, LV diastolic dysfunction, and left atrial (LA) enlargement are typical signs of hypertensive heart disease (HHD). The development of strain imaging, and three-dimensional echocardiography (3DE) has offered new approaches regarding perceptions of pathophysiology and also clinical implications in hypertensive patients.