Abstract Background: Orthostatic hypotension (OH) is a frequent concomitant disorder and a common co-morbidity in heart failure (HF). It has been associated with increased risk of mortality and CV morbidity. Prevalent OH may precede the incidence of heart failure (HF) and atrial fibrillation (AF). Aim of Study: To assess postural hypotension in chronic heart failure patients and its association with clinical mani-festations and echocardiographic parameters. Patients and Methods: The study included 100 patients who presented to National Heart Institute with symptoms and signs of chronic heart failure from November 2018 to Novem-ber 2019 and were subjected to thorough history taking, full examination for symptoms and signs of heart failure, 12 lead ECG, transthoracic echocardiography and 6MWT evaluation. Patients of the study were classified to two groups; Group A with OH and group B without OH. Results: One hundred patients hospitalized for HF [mean age: 58.64±12.91 years; 55% women] were examined with conventional echocardiograms and active-standing test. As-sociations of cardiac remodelling parameters with the differ-ence between supine and standing (after 3min) systolic/diastolic BP were examined. A total of 33 patients (33%) met conven-tional OH criteria; i.e. systolic/diastolic BP decreases by ³20/10mmHg. In comparison between the two groups (Group A with OH and group B without OH), OH group was associated with greater left atrial volume [p£0.001], and greater left ventricular mass [p=0.001]. Conclusion: It was clear that OH is associated with the presence of structural cardiac changes such as increased LVM and increased left atrial volume. These findings suggest that autonomic dysfunction promotes cardiac remodelling in HF.