Left ventricular hypertrophy is frequent in hypertension although there is no close correlation between the level of blood pressure and the cardiac mass. The HYCAR study has shown a dissociation in the reversibility of left ventricular hypertrophy: ramipril at doses of 1.25 or 5 mg per day reduces left ventricular mass independently of its effects on the blood pressure. Nevertheless, it remains to be shown by a prospective study that the reduction of the blood pressure and the cardiac mass have additional benefits in the prevention of coronary artery disease in hypertensive subjects. In the meantime, two points resume the objectives of treatment of hypertension with respect to left ventricular hypertrophy and coronary risk. Firstly, prevention of left ventricular hypertrophy is better than its cure. Early prevention is based on accurate measurement and interpretation of the blood pressure according to international recommendations. Prevention necessitates good control of the blood pressure and it would appear to be particularly effective in patients who respond well to angiotensin converting enzyme inhibitors. Secondly, when left ventricular hypertrophy is present, it is possible to reduce the left ventricular mass: however, it remains to be seen whether this is accompanied by a normalisation of structure and function. This requires control of the blood pressure using either an angiotensin converting enzyme inhibitor in good responders to this family of drugs or another type of antihypertensive agent. In the latter case, the association of a low dose of ramipril may be envisaged when left ventricular hypertrophy persists despite good control of the blood pressure. This hypothesis requires testing with an appropriate prospective therapeutic trial.