Left ventricular hypertrophy in systemic hypertension is an important independent risk factor for adverse cardiovascular events. Hypertrophy is due to increase of the myocytic and non-myocytic compartments of the myocardium. The changes in architecture, shape and function of the left ventricular is considered as remodelling. The concept of cardioreparation implies a restoration of structural (regression of both intersticial and perivascular fibrosis and myocyte hypertrophy) and functional consequences of remodelling. The concept of cardio-protection implies prevention of remodelling. Remodelling is caused not only because high pressure but there are many other factors, mainly hormonal, as activation of renin angiotensin aldosterone system promoting nuclear oncogens. Functional changes are mainly due to fibrosis with diastolic impairment at a first step and dilatation later. Therapeutic goal in systemic hypertension is to achieved, not only a normal pressure but a normal structural and functional heart.