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Background. The purpose was to determine prognostic factors of improving left ventricular diastolic function (LV DF) in resistant hypertension patients who received multicomponent antihypertensive therapy for three years. Materials and methods. One hundred and two patients with true resistant hypertension were included. They received triple fixed combination (renin-angiotensin-aldosterone system blocker/calcium antagonist/diuretic) to which the fourth drug (spironolactone, eplerenone, moxonidine, torasemide or nebivolol) has been added. The state of LV DF was evaluated at baseline and by the end of the study. Office and 24-h ambulatory blood pressure (BP) measurements, echocardiography, clinical characteristics, neurohumoral and proinflammatory status were assessed. Results. Impaired LV DF was detected in 75.5 % of patients. The first degree of LV diastolic dysfunction was observed more often, in 63.7 % of cases. The patients were divided into 2 groups: the first one included people without initial impairment of LV DF (n = 25), the second one consisted of those with LV diastolic dysfunction (n = 77). The latter were older, had a longer duration of hypertension, higher body mass index, 24-h urinary albumin excretion, office and 24-h ambulatory BP, they also more often (by 2 times) had disorders of circadian BP rhythm and concomitant diabetes. Left ventricular diastolic dysfunction in 100 % of cases was associated with severe LV hypertrophy, increased plasma concentration of inflammatory proteins (C-reactive protein, fibrinogen), cytokines (interleukin-6, tumor necrosis factor ), increased activity of leukocyte elastase, macrophage matrix metalloproteinase-12. The concentration in the blood of aldosterone, active renin, 24-h urinary excretion of metanephrines did not differ between the groups. Conclusions. Improvement and stabilization of LV DF occurred in parallel with regression of LV hypertrophy (normalization of LV mass index in 35.1 % of patients and its significant decrease in 64.9 %) against the background of a decrease in BP and in the proportion of patients with impaired circadian BP rhythm. The independent factors of the E/E' ratio were baseline plasma levels of aldosterone ( = 0.556, P = 0.0001), glucose ( = 0.366, P = 0.0001), active renin ( = –0.223, P = 0.004), 24-h urinary albumin excretion ( = 0.188, P = 0.016), age of patients ( = 0.192, P = 0.023). The odds of an improvement in LV DF increased by 3.7 times, if patients with resistant hypertension had no diabetes; LV hypertrophy regression occurred.