BACKGROUND: There are various causes of chest pain in hypertensive patients. Although chest pain in hypertensive patients have been studied, little information is available for prevalences and causes of chest pain in Korea. We investigated the clinical patterns, electrographic and echocardiographic parameters of hypertensive patients with chest pain according to coronary angiography. METHODS: From August 2006 to February 2007, a consecutive series of coronary angiography of hypertensive patients with chest pain was retrospectively reviewed. A baseline characteristics, causes of chest pain, electrocardiographic and echocardiographic parameters were analyzed also. RESULTS: Total of 440 patients was divided into two groups according to their coronary angiography results. 266 patients (60.5%) had significant coronary artery disease (CAD) and 174 patients (39.5%) had not. Electrocardiographic or echocardiographic left ventricular hypertrophy (LVH) was detected in 134 patients (30.5%), slow coronary flow was seen in 12 patients (2.7%), chest pain of non-cardiac origins was revealed in 19 patients (4.3%), chest pain of unknown origin was in 9 patients (2%). In multivariate logistic regression, left ventricular mass index (LVMI) and electrocardiographic LVH were significant parameters to predict the major cause of chest pain in hypertensive patients with normal or minimal coronary artery. CONCLUSION: The incidence of CAD was 60.5% in hypertensive patients with chest pain. LVH may be important factor in the pathogenesis of chest pain in hypertensive patients without significant CAD.