From the Guidelines

Hypertension with palpitations is an indication for echocardiography.

Echocardiography is recommended in hypertensive patients with cardiac symptoms, such as palpitations, to diagnose underlying disease 1.
It can help refine risk evaluation, detect left ventricular hypertrophy (LVH), and assess cardiac function and morphology 1.
The European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) recommend reserving echocardiography for individuals with hypertension in whom hypertensive cardiac disease or cardiac disease is suspected 1.
In patients with stage 2 hypertension or suspected target-organ damage, a screening echocardiogram is advisable to distinguish physiological hypertrophy from pathological LVH 1.

Echocardiography can detect LVH, which is a common cause of congestive heart failure in adults with hypertension 1.
It can also evaluate systolic and diastolic properties of the left ventricle, such as speed and extent of contraction, and end-systolic wall stress 1.
A complete 2D and Doppler study should be performed in patients with suspected hypertensive cardiac disease or cardiac disease associated with hypertension comorbidities 1.

From the Research

Echocardiography is a useful tool in the management of hypertension, providing important information on cardiac geometry, left ventricular systolic and diastolic function, and left atrial function 2.
The decision to perform an echocardiogram in patients with hypertension should be based on individual patient characteristics and risk factors, rather than as a routine test for all patients with hypertension 3, 4.

Patients with hypertension and symptoms such as palpitations, chest pain, or shortness of breath may benefit from echocardiography to evaluate for underlying cardiac abnormalities 5, 6.
Echocardiography may also be useful in patients with hypertension and suspected cardiac involvement, such as left ventricular hypertrophy or diastolic dysfunction 2, 5.

The Italian Society of Hypertension recommends echocardiography in patients with hypertension who have symptoms or signs of cardiac involvement, or who are at high risk for cardiovascular events 4.
The use of echocardiography in clinical practice should be guided by individual patient needs and risk factors, rather than as a routine test for all patients with hypertension 3, 2.

A study of 227 hypertensive patients over the age of 60 found that 92.5% had abnormal echocardiogram findings, including left ventricular hypertrophy, diastolic dysfunction, and mitral regurgitation 5.
Another study found that patients with left ventricular hypertrabeculation/noncompaction had a high prevalence of cardiologic and neurologic findings, regardless of the indication for echocardiography 6.