Background: Evidence supporting the hypothesis that both age-associated and systemic hypertension-associated changes in cardiovascular structure/function are implicated in the markedly increased risk for cardiovascular disease in older persons has been presented in the preceding research. This study was aimed to evaluate both age and systemic hypertension-associated cardiac mechanical changes by comparing with young healthy hearts. Methods: Total 51 patients (56짹14 years old, 20 male) with hypertension who never treated or discontinued medication at least 6 months were evaluated. After diagnosed hypertension with 24 hour ambulatory blood pressure monitoring, left ventricular (LV) function and mechanics were assessed with transthoracic echocardiography (TTE) using both conventional image and speckle tracking image, and then compared with those of 57 young healthy heart (12짹2 year old, all male). Pre-ejection counter twist was calculated by apical clockwise rotation minus basal counter-clockwise rotation in pre-ejection period. Results: Conventional parameter for systolic function was not different between adult hypertensive (AH) and young healthy (YH) group (ejection fraction = 63짹8 vs. 65짹8 %, p=0.314, respectively). But there were significant differences in peak systolic twist (9.1짹4.5 (AH) vs. 15.1짹6.4째 (YH), p<0.001, respectively) and untwist rate (-149짹57 (AH) vs. -255짹179 째/sec (YH), p<0.001, respectively). Pre-ejection counter twist was also significantly different between two group (-1.6짹1.3 (AH) vs. -3.1짹1.9 째 (YH), p<0.001, respectively). Conclusion: Systolic and diastolic impairment of cardiac twist mechanics are associated with aging and systemic vascular hypertension. Speckle tracking method of echocardiography provides useful information for discriminate pathologic heart from young healthy heart.