Left ventricular (LV) diastolic function changes were studied in 52 essential hypertension (EH) patients during 10-year follow-up. Initial LV diastolic function was estimated by Doppler echocardiography, after 10 years – by tissue Doppler imaging. Worsening of LV diastolic function was marked in EH patients both with initial left ventricular hypertrophy and with normal left ventricular mass. In EH patients without initial LV hypertrophy development or worsening of diastolic dysfunction was associated with thickening of LV wall (the relative thickness of LV wall (RWT) increased from 0.41±0.01 to 0.47±0.11; P<0.001), without significant changes of LV volume. At the same time, in patients with initial LV hypertrophy worsening of LV diastolic function was accompanied by increased thickness of LV wall (RWT was increased from 0.41±0.01 to 0.46±0.01; P<0.001) and reduction of LV volume ( index of LV end diastolic volume diminished from 71.7±2.9 to 65.6±2.1 ml/m2; P<0,05). Progression of LV diastolic dysfunction in EH patients depends on the initial size of LV mass index and initial LV diastolic dysfunction.