Left ventricular hypertrophy is an independent "risk factor" for all kinds of cardiovascular disease. Structural vascular changes are of importance for the maintenance and progression of high blood pressure. To try to achieve regression of these structural changes seems a logical option as part of a preventive strategy in hypertension. The effect of antihypertensive therapy on structural cardiovascular changes in animal models and man is reviewed. A prolonged normalization of blood pressure without reflexogenic activation of trophic factors, if possible started early in the development of hypertension seems to be the optimal therapy to attain regression. There are some data indicating that regression of cardiac hypertrophy can improve cardiac function and reduce arrhythmias and furthermore that regression of structural vascular changes can positively affect the progression of hypertension. Although these preliminary result look promising there are still no data on how regression induced by antihypertensive therapy affects the mortality and morbidity associated with left ventricular hypertrophy.