Recent reports have shown that four distinct left ventricular anatomical patterns, with different hypertension severity and hemodynamic features, are associated with sustained arterial hypertension (normal anatomy, concentric remodeling, concentric hypertrophy and eccentric hypertrophy). The aim of this study was to evaluate left ventricular diastolic function in these different left ventricular anatomic patterns. To achieve this aim, 94 borderline-to-severe essential hypertensive patients (60 never treated before, 34 off treatment for at least 3 weeks before the study) underwent an echo-Doppler study; left ventricular thickness, dimension and mass index were obtained. Early (E) and late (A) transmitral flow velocity, their ratio (A/E) and the early filling fraction (EFF) were obtained by pulsed-wave Doppler and used as left ventricular diastolic function indexes. Differences between groups were evaluated by one-way ANOVA followed by Scheffe F-test. A normal left ventricular anatomy was found in 41 (44%), concentric remodeling in 17 (18%), concentric hypertrophy in 21 (22%) and eccentric hypertrophy in 15 (16%) patients. Early filling fraction and A/E ratio which resulted were significantly different for the groups (P < 0.001 and P < 0.002, respectively). As compared with the group with normal left ventricle, patients with concentric hypertrophy had significantly EFF and those with eccentric hypertrophy had significantly lower EFF and higher A/E ratio. Our results thus confirm the presence of distinct anatomical left ventricular adaptation patterns in arterial hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)