Arterial hypertension heavily contributes to the global cardiovascular burden of morbidity and mortality, as well as to increase individual absolute cardiovascular risk. In addition, the clustering of cardiovascular risk factors and target organ damage in hypertensive patients is indeed an extremely frequent observation in both the epidemiological studies and in the clinical practice. In this view, a systematic research of intermediate endpoints or disease markers may represent an useful strategy in order to evaluate the presence of target organ damage as well as to predict cardiovascular events in essential hypertension. In fact, when considering the long natural history of hypertension, it appears very useful to postulate that modifications in measurable intermediate endpoints may permit a better evaluation of the efficacy of a given treatment in preventing or modifying the course of target organ damage, rather than variation in the future risk for development of hard endpoints. This represents a valuable approach in the clinical practice and can be easily undertaken by physicians to evaluate the status of a patient, the prognosis and the effectiveness of a treatment through a better stratification of absolute cardiovascular risk in individual patients, resulting in a more strict and cost-effective control of high blood pressure levels.