The variety of clinical information provided by the echocardiogram (i.e. assessment of left ventricular (LV) structure and geometry, systolic/diastolic function, left atrial and aortic size) in addition to its superior sensitivity for LV hypertrophy detection compared to electrocardiogram are strong arguments supporting the paramount importance of this technique in the assessment of hypertensive heart disease. A number of limitations of the echocardiographic technique, however, including lack of standardized/quantitative procedures, impair its diagnostic accuracy and cost-effectiveness. The aim of these recommendations is to provide a document on the minimum acceptable requirements for the clinical practice of echocardiography in the hypertensive setting and thus to improve the quality of this fundamental tool in the cardiovascular risk stratification of hypertensive patients.