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Introduction: In patients with arterial hypertension and chronic kidney disease (CKD), the prevalence of diastolic heart failure (HF-PEF) is probably very high. However, in these patients the diagnosis is difficult, especially because the signs and symptoms suggestive of HF-PEF are very common in CKD; in these cases the detection of left ventricular structural and functional alterations (as reported in the 2012 ESC guidelines on heart failure), assumes a decisive role for the diagnosis of HF-PEF. Aim: To evaluate the prevalence of patients with diastolic dysfunction according to ESC guidelines 2012 in a population of Hypertensive patients with CKD. Methods: We studied 466 hypertensive patients with mean age of 62.3 ± 12.6 years (M/F = 262/204) suffering from chronic kidney disease (stages 3-4-5 KDIGO), with a mean value of GFR equal to 26.8 ± 15.1 mL/min/1.73 m2. The criteria for exclusion from the study were: EF\50 %, other cardiovascular diseases that could cause heart failure. Were considered with diastolic dysfunction, all patients with a value of Em (evaluated with tissue Doppler imaging at lateral mitral annulus) less than 10 cm/s. Results: We found a value of Em \10 cm/s in 331/466 patients (71 %). In order to determine the role of CKD to explain the very high prevalence of diastolic dysfunction, we selected 160 hypertensive patients with overlapping features to the previous group with regard to age, sex, BMI, etc. In this population the prevalence of diastolic dysfunction was 43.7 %. Conclusions: Our findings demonstrate a very high prevalence of diastolic dysfunction in the studied population; it is possible to assume that a large proportion of these patients had HF-PEF or is at high risk for its development. The finding of a lower prevalence of diastolic dysfunction in a hypertensive population supports the hypothesis of a decisive role of CKD in determining diastolic dysfunction and HF-PEF.