Summary: One of the most common complications of high blood pressure is left ventricular hypertrophy (LVH). One of the consequences of LVH in patients with arterial hypertension, which is of increasing importance due to the aging of the population and its incidence, is heart failure, especially heart failure with a preserved ejection fraction. The use of perindopril-based dual and triple combinations is associated with a significant reduction in left ventricular mass index and LVH. An early, intensive, guideline-based strategy based on drugs with a demonstrated effect of reducing left ventricular mass is likely to end the sequence of adverse events and reduce the risk of developing heart failure, the inevitable sequelae of poorly or too late controlled hypertension.