Background Variables to predict dynamic mid-ventricular or left ventricular outflow tract(LVOT) obstruction after inotropic provocation are not well established. We were to assess the additive role of Valsalva maneuver to predict dynamic intraventricular obstruction(IVO) during dobutamine stress echocardiography(DSE) in patients with hypertension.Methods and Results Prospectively enrolled hypertensive patients (mean age 67짹10 years; 23% male) underwent Doppler examination of the left ventricular(LV) cavity at rest, after Valsalva maneuver, and at peak dobutamine infusion. The patients with transmural infarction, significant valvular heart disease, atrial fibrillation, and beta-blocker therapy were excluded. The development of an IVO was defined as a late-peaking intraventricular pressure gradient(IVPG) >30mmHg. The patients with IVO (n=20,) and without IVO (n=10, non-IVO) were not different in terms of age, sex, smoking status, and used hypertensive drugs. IVO group had smaller LV cavity, LV volume, and stroke volume and higher basal septal thickness than non-IVO group. LVOT obstruction related to systolic anterior motion of the mitral valve (SAM) induced during DSE was occurred in 6(30%) of IVO group. Although baseline IVPG was not different significantly in both group, IVPG after Valsalva maneuver was higher in IVO-group(3.8짹3.1 vs 15.8짹16.4 mmHg, p<0.01) and IVPG after peak dose of dobutamine was also higher in IVO group(17.4짹9.3 vs 88.7짹37.5 mmHg, p<0.01).Conclusion Simple Valsalva maneuver might have an additive role to predict dynamic IVO in patients with hypertension who are good candidate for beta-blocker therapy.