The left ventricular twist was evaluated by 2-dimensional ultrasound speckle-tracking imaging (STI) in 50 patients with hypertension with normal geometric left ventricle (LV) and 45 normal subjects as control group. The mean value of LV rotation was obtained at each plane using STI. LV twist and twist velocity were defined as apical rotation/rotation rate relative to the base respectively. To adjust the intersubject differences in heart rates, the time sequence were normalized. The results showed that peak twist developed near the end of systole. Peak LV twist was significantly higher in patients with hypertension than normal controls (P<0.001). The diastolic untwisting mainly occurred in early diastole ( approximately 38%). Compared with normal controls, untwisting rate (Untw R) in patients with hypertension was significantly reduced (P<0.001), and untwisting half-time (UHT) was significantly delayed (P<0.05). This study demonstrated that STI has a potential ability to evaluate the early change of heart function in patients with hypertension by measuring the twist of LV.