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Hypertension and aging adversely affect cardiovascular system and the heart is invariably involved. Manifestations of hypertensive heart disease and of the aging heart appear similar; ventricular hypertrophy, myocardial fibrosis, and impairments in ventricular function and coronary hemodynamics characterize both conditions. However, a great deal of evidence suggests that different underlying pathophysiological mechanisms may be involved. This report discusses most recent clinical and experimental findings and focuses on the alterations in nonmyocytic elements that are a part of heart involvement. Particular attention was given to factors that are responsible for exaggerated myocardial deposition of collagen that, by itself, may be responsible for ventricular dysfunction and impaired coronary hemodynamics in hypertensive and aging hearts. Newly developed therapeutical strategies, based on the most recent experimental and clinical studies, are also discussed.