Within the latest ten years research in left ventricular hypertrophy as cardiac target organ damage has uncovered its prognostic importance, and studies indicate that treatment with angiotensin II receptor blockade is most effective in reducing left ventricular hypertrophy. In addition, reduction of left ventricular mass is associated with substantial and significant reduction of cardiovascular morbidity and mortality. Hypertension is strongly associated with increased risk of subsequent heart failure. Meta analysis data suggests that reduction in blood pressure is also associated with very substantial reductions in incident heart failure. In addition, the authors suggest that atrial fibrillation should be considered target organ damage with the resulting implications in terms of blood pressure reduction in guidelines, and that modern treatment of atrial fibrillation should also include reduction of traditional cardiovascular risk factors as well as blood pressure reduction for blood pressures exceeding 130/185 mmHg. Reductions which should be achieved using angiotensin converting enzyme inhibitor or angiotensin receptor blockers in order to improve the hemodynamic status of the patient.