OBJECTIVE:The association between pre-hypertension (pre-HTN) and subclinical cardiac organ damage is not well defined. We performed a systematic meta-analysis of echocardiographic studies in order to provide a comprehensive information on cardiac structural and functional changes in untreated pre-HTN subjects. DESIGN AND METHOD:Studies were identified by crossing the following search termspre-hypertension, high normal blood pressure, heart, left ventricular hypertrophy, left ventricular function, diastolic function, left atrial size, aortic root size, echocardiography. RESULTS:A total 73,556 subjects (44,170 normotensive, 17,314 pre-HTN, and 12,072 HTN individuals) of both genders were included in 20 studies. Left ventricular (LV) mass index was greater in pre-HTN than in normotensives (standard means difference SMD0.32 ± 0.07, p < 0.001). Mitral E/A ratio was lower (SMD−0.34. ± 0.05,p < 0.001), E/e’ ratio (SMD0.26 ± 0.02, p < 0.001) and left atrium (LA) diameter higher (SMD0.55 ± 0.02, p < 0.001) in pre-HTN than in normotensive counterparts. HTN subjects showed a greater LV mass index (SMD0.27 ± 0.03, p < 0.001), reduced E/A (SMD−0.38 ± 0.08, p < 0.001), increased E/e’ ratio (SMD0.38 ± 0.09, p < 0.001), and LA diameter (SMD0.31 ± 0.12, p < 0.001) than pre-HTN subjects CONCLUSIONS:Our meta-analysis shows that alterations in cardiac structure and function in pre-HTN subjects are intermediate between normotensive and HTN individuals. These findings reinforce the view that pre-HTN should not be longer considered a benign entity.