Arterial hypertension is the commonest cause of heart failure in the Savannah region of Nigeria. The prevalence of diastolic dysfunction in patients with hypertensive heart failure in this region is unknown. This needs to be determined, since it may influence therapy. Left ventricular function of 95 patients with hypertensive heart failure and 92 age-/sex-matched, healthy normotensive control was determined by echocardiography using ALOKA SSD 1700 two-dimensional echocardiograph/ Doppler and color flow ultrasound machine. Compared to the controls, the hypertensive heart failure patients had increased left ventricular mass index (LVMI), p = 0.0001; cardiothoracic ratio (CTR), p = 0.0001; and electrocardiographic left ventricular hypertrophy (ECG-LVH), p = 0.0001. Isolated diastolic dysfunction, E/A ratio < 1.0, and EF > 50%, was seen in 12 patients (12.6%). Twenty-three patients (24.2%) had combined diastolic and systolic dysfunction (E/A ratio < 1.0 and EF < 50%). Six patients (6.3%) had pseudonormalization (E/A ratio 1.0-2.0 and deceleration time, DT, 150-200 msec), while restrictive pattern of diastolic dysfunction was seen in 25 patients (26.3%). This prevalence of 69.4% of diastolic dysfunction in Nigerians with hypertensive heart failure seen in this study emphasizes the need for Doppler echocardiographic evaluation and diagnosis where these facilities are available. This will aid the physician to prescribe appropriate treatment.