The heart is of great importance in systemic hypertension; it has a role in its pathogenesis but also suffers its consequences. Heart disease is, therefore, often found in hypertensive patients. Patients with hypertension may develop left ventricular hypertrophy, cardiac failure and atherosclerotic vascular problems, such as coronary artery disease, as well as strokes and peripheral vascular disease. There have been a great many advances in our understanding of the pathogenesis of hypertensive heart disease as well as its epidemiology over the last decade and these are reviewed briefly here.