The dangers of hypertension have long been familiar to everyone, and the organs it damages are the heart, brain, kidneys, and peripheral vasculature. But the most important target organ is the heart. Studies have shown that if a patient is in a state of high blood pressure for a long time, the left ventricle will be under greater pressure. Prolonged ventricular compression will likely trigger increasing interstitial fibers and cardiomyocyte hypertrophy. The end result of cardiac damage is cardiac insufficiency, also known as heart failure. The most prominent pathological change is left ventricular hypertrophy (LVH), which is a sensitive indicator of early heart damage. What is LVH? Left ventricular hypertrophy is a phenomenon of myocardial changes with thickening of the ventricular wall, increased myocardial weight and myocardial remodeling, which is an independent risk factor for various cardiovascular diseases. According to statistics, the proportion of hypertensive patients with left ventricular hypertrophy is as high as 42.8%. And the incidence is positively correlated with the severity of hypertension. Therefore, an early measure to prevent hypertensive heart failure is to identify and prevent/reverse left ventricular hypertrophy. Recognizing and Preventing LV Hypertrophy First, we need to find out whether hypertensive patients have left ventricular hypertrophy at an early stage. There are four main ways to detect left ventricular hypertrophy: ① Electrocardiogram (ECG) is the main screening method for hypertension combined with left ventricular hypertrophy; however, its accuracy and sensitivity are low. According to some data, the positive rate of left ventricular hypertrophy judged by ECG can be up to 60%, but generally 30% to 40%. ② Echocardiography (UCG, ECHO) diagnosis of left ventricular hypertrophy sensitivity is much higher than ECG, its accuracy and specificity of 85%, UCG test has the advantages of accuracy, simplicity, non-invasive, etc., for the main diagnostic methods for hypertension patients to check and diagnose left ventricular hypertrophy. Although left ventriculography is the most reliable method to diagnose left ventricular hypertrophy, it is invasive and not easy to repeat, so its clinical application is limited. Cardiac magnetic resonance imaging (CMR) is a new method for diagnosing left ventricular hypertrophy in recent years and can be used as a differential diagnosis of left ventricular hypertrophy. Reversing left ventricular hypertrophy Secondly, it is necessary to prevent/reverse left ventricular hypertrophy. LV hypertrophy is reversible, and numerous studies have shown that prevention/reversal of LVH significantly reduces cardiovascular event morbidity and mortality. A meta-analysis that included 5 studies with 2449 patients showed that hypertensive patients with reversed/continuously normal LVH had a 46% lower risk of total cardiovascular events. It has been shown that reversal of LVH leads to a reduction in a range of clinical endpoints in patients, including cardiovascular death, myocardial infarction, stroke, and heart failure. Currently, it is believed that the first step in controlling hypertension to prevent heart damage is to achieve the blood pressure standard, and the second “second target” is to control or avoid the occurrence of left ventricular hypertrophy. The Chinese Guidelines for the Prevention and Treatment of Hypertension 2010 recommend that patients with hypertension and LVH should be referred to patients with heart failure, and that the target blood pressure should be <130/80 mm Hg. For patients with hypertension and LVH, the first step should be to control the blood pressure to reach the target, and for the selection of medication to address the mechanism of hypertension-induced LVH, medications with evidence-based evidence for improving LVH should be preferred. The occurrence of LVH in primary hypertension signifies a deepening of the risk of hypertension and damage to target organs, and the mortality rate of hypertensive patients with LVH is significantly higher than that of hypertensive patients without LVH. Therefore, it is important to recognize and reverse this condition early in the clinical setting.