Abstract: AIM: To investigate the effect of different dosages of bisoprolol on the diastolic function of elderly hypertensive patients with diastolic heart failure. METHODS: Ninety-two hypertensive subjects with diastolic heart failure and left ventricular ejection fraction (LVEF) >50% according to the treatment of amlodipine were randomly divided into three groups: control (no bisoprolol given), low-dose group (bisoprolol 1.25 mg qd) and high-dose group (5 mg qd of bisoprolol). Left ventricular end-systolic diameter (LVED), interventricular septal diameter (IVSD), posterior wall thickness (PWT), LVEF, mitral valve E wave, A wave and E/A ratio, E wave velocity time integral (VTIE), A wave velocity time integral (VTIA) and VTIE/VTIA were assessed by echocardiography at baseline and 30 weeks after. RESULTS: No significant changes were seen in LVEF and systolic blood pressure after treatment compared with those at baseline. Diastolic blood pressure and heart rate decreased significantly in the low-dose group ［(86±4) vs.(75±9) mmHg, (75±9) vs.(71±6) l/min］ and high-dose group ［(87±4) vs.(76±10) mmHg, (71±8) vs.(68±12) l/min, P<0.05］ compared with those at baseline and those in the control group. Left ventricular diastolic function (E, A, E/A, VTIE, VTIA, E-VTI/A-VTI) in low-dose group and the high-dose group improved significantly, but the changes in the high-dose group were more obvious than those in the low-dose group (P<0.05). LVED (53.9±3.7 vs. 48.6±2.9), IVSD (11.2±1.5 vs. 7.8±0.7), PWT (9.2±2.8 vs. 8.2±2.8) and LVMI (121±48 vs. 97±20) decreased significantly in the high-dose group (P<0.05), whereas no obvious changes were seen in the contol group. CONCLUSION: Based on the treatment of amlodipine, bisoprolol improves the diastolic function of hypertensive patients with diastolic heart failure but with well-controlled blood pressure. Higher doses have a more obvious effect.