Objective To analyze the data obtained from treadmill echocardiography (TESE) of myocardial microcirculatory injury in patients with primary hypertension and to investigate the relationship between myocardial microcirculatory injury and TESE parameters in those patients and its possible mechanism. Methods A total of 47 patients with clinically diagnosed primary hypertension were enrolled from June 2018 to June 2019. All patients underwent TESE within one week. At the same time, myocardial microcirculation perfusion was evaluated in combination with myocardial contrast echocardiography (MCE). According to imaging of myocardial microcirculation, hypertensive patients were divided into normal group and abnormal group. An analysis was done of the correlation between myocardial microcirculatory injury and TESE parameters in patients with primary hypertension and its possible mechanism. SPSS statistics 23.0 was used for data analysis. Results In patients with primary hypertension, there was no significant difference in the association between the severity of hypertension and myocardial microvascular injury (P>0.05). In the abnormal group, higher peak systolic blood pressure, lower metabolic equivalents (METs), lower cardiac dysfunction index, shorter exercise time, thicker interventricular septum thickness (IVST) and left ventricular posterior wall (LVPWT), and lower peak left ventricular ejection fraction (LVEF) than in the normal group (P<0.05). Multivariate analysis showed that, in patients with hypertension, myocardial microcirculatory injury was negatively correlated with chronotropic function and peak LVEF (OR=0.002,95%CI 0.000-0.981, P=0.049; OR=0.000, 95%CI 0.000-0.028, P=0.002) and positively correlated with LVPWT (OR=3.745,95%CI 1.301-10.774, P=0.014). Conclusion TESE can evaluate cardiac structure and functional status before and after exercise, and exercise tolerance in patients with hypertensive myocardial microcirculatory injury, which is worthy of clinical application. Myocardial microcirculatory injury inpatients with primary hypertension is associated with cardiac chronotropic function, suggesting that autonomic dysfunction may be involved in the pathogenesis of myocardial microcirculatory injury in patients with primary hypertension.