Hypertensive heart disease (HHD) has been considered the adaptive hypertrophy of the left ventricle wall to increased blood pressure. Recent findings in hypertensive animals and patients now challenge this paradigm by showing that HHD also results from pathologic structural remodeling of the myocardium in response to hemodynamic and nonhemodynamic factors that are altered in arterial hypertension. The possibility that hypertensive patients predisposed to develop heart failure may be detected before the appearance of clinical manifestations provides a new way to prevent this major arterial complication.