While the recent evolution of guidelines for arterial hypertension also includes the need to evaluate coexistent cardiovascular risk factors and target organ damage in the base work-up for arterial hypertension, it does not include echocardiography systematically, because there is no evidence that information on LV geometry and function can modify management strategy in every circumstance, and there is concern about the technical variability of repeated echocardiographic examinations in the individual patient. The present issue of the Journal publishes a paper showing that adherence to the 1993 World Health Organization – International Society of Hypertension recommendations leaves untreated a proportion of patients with ‘mild hypertension’ who instead would have been treated if decision was also based on echocardiographic information on LV geometry. These findings challenge the most recent positions of national Societies, reserving the indication for echocardiography to patients with high risk (the vast majority). The present study appears indeed to reinforce the notion that echocardiographic examination might be very important in patients in whom, based on guidelines adherence, no pharmacological treatment would be required, whereas, based on the present evidence, echocardiographic information might be less important and perhaps superfluous for decision making in patients assigned to a high risk score, for whom aggressive treatment has been already scheduled.