Several prospective epidemiological and clinical studies have indicated that regression of cardiovascular alterations, preferably at an early stage, is a desirable goal in the treatment of hypertension. The results of a large number of studies have indicated that many antihypertensive drugs can produce a significant regression of cardiovascular structural changes in hypertensive patients. However, it has not been established whether a complete 'normalisation' may occur. Further studies are needed to identify factors that modulate regression of cardiac and vascular smooth muscle hypertrophy. Most important, it remains to be clarified whether regression of cardiovascular structural changes significantly improves prognosis per se independently from blood pressure reduction.