The current diagnostic criteria for uncomplicated mild hypertension inadequately distinguish the subgroup actually at increased risk for cardiovascular sequelae, from the large group not at increased risk, and therefore unlikely to benefit from current pharmacological intervention. Although finding of electrocardiographic left ventricular hypertrophy indicates increased risk, the ECG lacks sufficient sensitivity to be diagnostically useful in mild hypertension. It can be argued that echocardiographic screening for LV hypertrophy may better detect the subpopulation of mildly hypertensive patients at increased risk. The known relationships between ambulatory BP, LV hypertrophy and prognosis support this hypothesis. Further study is required, however, before echocardiography can be advocated for routine application to the diagnosis and management of mild hypertension.