Our understanding of left ventricular hypertrophy has increased considerably in recent years with the introduction of new investigative techniques and the publication of clinical and epidemiological studies. The mechanism of the genesis of LVH is complex and multifactorial: besides the purely mechanical explanation which places LVH in a purely compensatory complex, counteracting the increase in left ventricular load, many other factors have been incriminated including a genetic predisposition and neurohormonal activation. A long phase of compensation is followed by ventricular insufficiency and cardiac failure. In addition, LVH has been identified as an independent cardiovascular risk factor for increased morbidity and mortality. Partial regression of LVH after surgical correction of valvular disease and especially after treatment with certain antihypertensive drugs, should be considered with great interest, even though the long-term prognosis of this regression remains uncertain.