Resistant hypertension (RH) is associated with a high burden of cardiovascular morbidity and mortality. Early detection of subclinical myocardial dysfunction is essential for risk stratification and timely therapeutic intervention. Speckle tracking echocardiography (STE) is an advanced imaging technique that enables sensitive assessment of myocardial mechanics and can identify subtle functional abnormalities before changes in conventional parameters such as ejection fraction become apparent. This review summarizes the current evidence on the role of STE in evaluating left ventricular (LV) and left atrial (LA) myocardial deformation in patients with uncontrolled hypertension and RH. Available data indicate that STE-derived indices, particularly LV global longitudinal strain and LA phasic strain parameters, are frequently impaired in these populations, reflecting early myocardial dysfunction. However, other components of myocardial deformation, including circumferential strain, radial strain and twist mechanics, remain insufficiently investigated in patients with RH. In addition, the absence of multimodality imaging validation and incomplete exclusion of coexisting coronary artery disease in several studies represent important limitations. Overall, STE appears to be a valuable tool for the early detection of subclinical LV and LA dysfunction in RH, and may enhance clinical risk stratification. Further well-designed prospective studies incorporating comprehensive strain analysis and multimodality imaging are required to better define its prognostic and therapeutic implications.