Objective: The objective was to investigate the structural changes in the left atrium (LA) and left ventricle (LV) of obese hypertensive patients. Materials and Methods: A total of 381 hypertensive subjects were divided into normal weight, overweight, and obese groups based on their body mass index (BMI). Clinical information and echocardiographic measurements of LA and LV were compared in the three groups. Results: Mean age was 52.4 ± 13.3 years (male:female ratio of 1.3:1). LA size was signifi cantly higher in obese hypertensives (4.4 ± 0.6 cm) compared with overweight (3.8 ± 0.7 cm) and normal weight hypertensives (3.4 ± 0.6 cm). Majority of the obese hypertensives (80.5%) had various degrees of LA abnormalities when compared with overweight (31.1%) and normal BMI subjects (18.3%). The prevalence of left ventricular hypertrophy (LVH) was 29.1%, 22.6%, and 13.9% in the obese, overweight, and normal BMI subjects, respectively. Concentric LV geometry was found in the majority of the obese subjects (79.6%). Conclusion: There are signifi cant differences in the prevalence and severity of abnormalities of LA as well as the degree and prevalence of LVH in obese hypertensive patients compared with the non-obese counterparts. Concentric LV geometry is the dominant phenotypes seen the obese patients.