Hypertension is a leading cause of major adverse cardiovascular outcomes, including heart attacks and stroke. The most visible manifestation of target organ damage related to hypertension is left ventricular hypertrophy (LVH). LVH eventually predisposes to systolic and diastolic heart failure, and is associated with an even greater risk of stroke. Electrocardiography and echocardiography are usually used to quantify LVH, but cardiac MRI may be a more reproducible and accurate modality. Regression in LVH is associated with improved cardiovascular outcomes. Treatments aimed at LVH regression include restriction of salt, regular exercise and weight reduction. Blockade of the renin-angiotensin-aldosterone system is particularly effective in preventing cardiovascular and cerebrovascular events, and is often associated with the regression of LVH, a decrease in left atrial size and a reduced incidence of new-onset atrial fibrillation, which could all contribute towards a decrease in vascular events. Overall, a reduction in blood pressure is still the most important factor in prevention of disease progression, and early treatment averts the risk of subsequent heart failure and stroke.