Abstract: Objective To categorize the patterns of abnormalities in exercise ²⁰¹TI myocardial scintigraphy and explore the mechanisms. Methods Exercise ²⁰¹TI myocardial scintigraphy was performed in 203 patients with clinically suspected coronary artery disease, including 74 normotensive patients, 78 hypertensive patients without left ventricle hypertrophy (LVH) and 51 hypertensive patients with LVH. All the patients underwent coronary angiography one month before or after ²⁰¹TI myocardial scintigraphy, and the patterns of abnormal findings were categorized as segmental, non-segmental and mixed patterns. Patients with abnormal ²⁰¹TI myocardial perfusion and normal coronary angiographic findings were followed up. Results In hypertensive patients without and with LVH, the ratios of abnormal perfusion in segmental, non-segmental and mixed types were 52/60 and 32/58, 4/60 and 9/58, and 4/60 and 17/58, respectively. The ratios of normal coronary angiography in the 3 types were 17/84, 13/13 and 10/21, respectively. Among the 40 patients followed up, 5 with segmental abnormality and 2 with mixed abnormalities developed large coronay artery disease, which was found in none of the patients with segmental abnormality. Conclusions In hypertensive patients with and without LVH, segmental perfusion abnormalities may be attributed to the anatomic and functional stenosis of the large coronary arteries, and the non-segmental abnormal perfusion might be only possible with coronary microvascular diseases.