Mrs Afroza, 48 years old, housewife came to the outpatient department with a 3 days history of central chest pain & the pain was also radiating to left shoulder & neck. She is diabetic (type 2) for last 8 years & hypertensive for 13 yrs & she was pre-echlamptic during her first pregnancy. On general examina- tion her blood pressure was 180 over 130mmHg & the patient was mildly anemic. Precordium examination revealed soft 1st heart sound in mitral and tricuspid area, pan systolic murmur in left lower parasternal area. ECG & Doppler Echocardiogram was done. Echocardiogram showed increased left ventricular wall thickness concentrically & hypokinetic anterior wall. Non coapted mitral & tricuspid valve & Doppler study showed mo- saic flow across the mitral & tricuspid valve during systole. The patient was diagnosed as a case of hypertensive heart disease as her blood pressure was not under control & eco showed con- centric left ventricular hypertrophy, mild left ventricular systolic dysfunction, mitral regurgitation (trivial) & mild tricuspid regur- gitation with mild pulmonary artery hypertension (pulmonary artery systolic pressure-35mmHg).Previously patient took Amlodipine for high blood pressure. But the condition was not good. Then Telmisartan and Amlo- dipine was prescribed for her high blood pressure.In developed countries, HHD are relatively common, espe- cially in older age group. These are usually due to high fat diet, less physical activity. Positive family history & person age, high blood glucose level are also a major risk factor.