Myocardial perfusion scintigraphy (MPS) is one of the most commonly used imaging studies to assess coronary flow status and to evaluate patients with respect to the probability of coronary artery disease. However, some authors have raised concerns about the accuracy of MPS in patients with hypertension (HTN). For example, Fragasso et al showed a specificity and positive predictive value of 36% and 67% for MPS in patients with HTN and concluded that MPS traces perfusion abnormalities, not necessarily caused by epicardial CAD, possibly due to sequelae of microvascular disease. These findngs may lead to unnecessary cardiac catheterization. It has been stated that several mechanisms in HTN might hamper coronary flow reserve and leading to angiographically negative but scintigraphically positive studies, meaning reduced specificity of MPS if coronary catheterization is considered as the gold standard. Among these probable mechanisms left ventricular (LV) hypertrophy and microvascular disease are the most important potential factors which are independent of the presence of significant CAD. These are the same explanations for abnormalities of ST-T segment on resting ECG (electrocardiographic strain pattern or left ventricular hypertrophy), which often make the application of ECG stress test unreliable, making it necessary to bring into play imaging techniques, such as MPS. As HTN is one of the most common risk factors in patients with CAD and frequently seen in patients undergoing MPS for noninvasive assessment of CAD, it is critical to make sure that the accuracy of the technique is not affected by the presence of HTN.