Objective: The aim of this study was to investigate the relationship between the myocardial performance index (MPI) and left ventricular (LV) geometry in hypertensive patients. Methods: The MPI, which is a marker of systolic and diastolic ventricular function, was measured in 64 hypertensive patients and in 15 healthy persons (Control). According to the value of relative wall thickness (RWT) and LV mass index (LVMI), hypertensive patients were subdivided into four groups: normal (N), 17 patients (26.6%); concentric remodeling (CR), 21 patients (32.8%); concentric hypertrophy (CH), 16 patients (25%); and eccentric hypertrophy (EH), 10 patients (15.6%). Results: A higher MPI was found in all patient groups (N, 0.56 ± 0.11; CR, 0.59 ± 0.11; CH, 0.68 ± 0.19; EH, 0.57 ± 0.10) compared with the controls (0.44 ± 0.09) (p = 0.004, p < 0.001, p < 0.001 and p = 0.002, respectively). In the CH group, the MPI was also higher than in N, CR and EH groups (p = 0.006, p < 0.03 and p = 0.009, respectively). No significant difference was found among N, CR and EH groups. The MPI was correlated with LVMI (r = 0.28, p = 0.014), RWT (r = 0.24, p = 0.035) and interventricular septum diastolic thickness (r = 0.32, p = 0.004). Conclusion: The systolic and diastolic LV functions are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric hypertrophy than in those with the other LV geometric patterns.