Purpose: We sought to investigate the usefulness of stress echocardiography-derived E/e’ in predicting subclinical atherosclerosis in asymptomatic hypertensive patients. Materials and Methods: 71 newly diagnosed untreated hypertensive patients (48 ± 13 years, 65% males) and 30 age- and sexmatched healthy controls were recruited. Resting and Coronary flow reserve (CFR) was evaluated as well. Results: Based on CFR values, newly diagnosed, untreated hypertensives were stratified into hypertensives with microvascular dysfunction (MVD; 34 patients had CFR < 2.0) and those without MVD (37 patients had CFR ≥2.0). Patients with MVD had a significantly higher C-reactive protein level (p < 0.05) and lower metabolic equivalent values (p < 0.05). With resting echocardiography, only the left atrial volume index (LAVI) was significantly increased in those with MVD compared with those without MVD and controls (p < 0.05). With exercise echo, the E/e’ was significantly increased in MVD patients compared with those without MVD and controls (p < 0.001). Importantly, the percentage of subjects with exercise E/e’ ≥15 was 76.5% (26 patients in the group with MVD), trols. At univariate analysis, high-sensitivity C-reactive protein (p < 0.05), LAVI (p < 0.05), and exercise E/e’ (p < 0.001) were independently associated with reduced CFR. On the other hand, at multivariate analysis, only exercise E/e’ was the independent predictor of reduced CFR in newly diagnosed hypertensives. Conclusion: We have demonstrated significant associations between exercise-derived raised left ventricular pressure and coronary MVD in newly diagnosed untreated hypertensive patients. Herein, we supposed that exercise-derived E/e’ could predict subclinical atherosclerosis and might be a risk parameter for newly diagnosed untreated hypertensive patients