Left ventricular hypertrophy (LVH) is both a target organ response to arterial hypertension and a disorder that may be responsible for increasing risk of cardiovascular events, including coronary artery disease (CAD) events, in the elderly population. Hypertension and obesity are the strongest risk factors for LVH, and both disorders are more likely to occur with age. Not surprisingly, the prevalence of LVH markedly increases with age. Although LVH may initially be a compensatory mechanism to reduce ventricular wall stress, substantial data indicate that as LVH progresses, coronary flow reserve is reduced, and CAD events are increased. Furthermore, LVH leads to systolic and particularly, diastolic ventricular dysfunction, and an increase in the prevalence and complexity of ventricular dysrhythmias. All types of cardiovascular morbidity and mortality also are increased in patients with LVH. Pharmacologic and nonpharmacologic strategies that may decrease LVH and potentially reduce cardiovascular morbidity and mortality in the elderly are reviewed.