Background: The present study aimed at evaluating the feasibility of using presystolic wave as an indicator of early myocardial damage in patients with essential hypertension. Methods: The present study included 90 patients diagnosed with hypertension. The patients were divided into two groups on the basis of whether they exhibited the presence of PSW (n = 64, age: 56 ±11 years) or its absence (n = 26, age: 58 ±13 years), as revealed by the results of left ventricular outflow Doppler echocardiography. The levels of Heart-type free fatty acid-binding protein were compared between the two groups. Results: In the 90 hypertensive patients included in the present study, the prevalence of presystolic wave was determined to be 71%. The Heart-type free fatty acid-binding protein levels in the non-PSW patients were observed to be statistically higher than those in the PSW patients [4.88 ng/mL (2.82–17.83) vs. 3.99 ng/mL (2.57–17.87), p = 0.041]. Even though the ejection fractions and the left ventricular diameters were within the normal limits for the patients of both the groups, the value for the left ventricular end-diastolic diameter was observed to be statistically higher in the non-PSW group. No differences were observed in the mitral flow parameters between the two groups. Conclusion: The present study demonstrated that the absence of presystolic wave in the hypertensive patients with preserved left ventricular ejection fraction is an indicator of subclinical myocardial damage. The hypertensive patients exhibiting the absence of the presystolic wave should be strictly followed up for cardiac complications.