Objective?To study the diagnostic value of real-time three-dimensional speckle tracking imaging (3D-STI) in patients with hypertensive hypertrophy (LVH)，to improve the accuracy of relevant diagnosis. Methods?Fifty patients with essential hypertension admitted to Nanhai Hospital of Guangdong Provincial People's Hospital and diagnosed with left ventricular hypertrophy (LVH) by echocardiography from March 2019 to January 2020 were selected and divided into a stenosis group (30 cases, ≥ 50% stenosis in one or more branches) and a non-stenosis group (20 cases,＜50% stenosis)?according to the results of coronary angiography (CA). 3D-STI technique was used to detect the two groups of patients. The data of laboratory examination indicators and strain values in the two groups were compared and analyzed. Receiver operating characteristic (ROC) curve was used to evaluate 3D-STI technique and obtain the predictive value of peak strain value for hypertensive LVH with coronary heart disease. Results?The values of mAlb, Cr, Hcy, hs-CRP, NT-ProBNP, cTNT and other indicators in the stenosis group were higher than those in the non-stenosis group (P ＜0.05). LVEDd, LAD and Lvmass in stenosis group were higher than those in non-stenosis group, while LVEF and 3D-LVEF were lower than those in non-stenosis group (P ＜0.05). There was no significant difference in LVST between the two groups (P ＞0.05). The local strain values of the stenosis group were generally lower than those of the non-stenosis group (P ＜0.05). According to the ROC curve, the maximum area under the ROC curve can be obtained by GCS (-27.2) and GRS (28.9). Among them, The sensitivity and specificity of GAS and GCS were 0.900 and 0.930, respectively, and the maximum AUC value of GAS was 0.923. Conclusion?3D-STI has the characteristics of noninvasive, convenience and accuracy, which can provide more accurate reference data for the early evaluation and diagnosis of coronary heart disease in hypertensive patients with LVH, and has important medical value.