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Data on left ventricular hypertrophy (LVH) in patients with renal artery stenosis (RAS) and its regression following renal revascularization are scanty. We performed a meta-analysis to provide comprehensive information on this clinically relevant issue.Full articles providing data on: LVH, as assessed by echocardiography, in RAS patients as compared with essential hypertensive counterparts; changes of left ventricular (LV) mass index after renal artery revascularization were considered.A total of 905 study participants (RAS = 446, essential hypertensive = 459) of both sex were included in nine studies. Pooled LV mass index was higher in RAS than in essential hypertensive patients (140.4 ± 11.1 g/m2 versus 121.8 ± 6.2 g/m2, standard mean difference being 0.41 ± 0.07 [95% confidence interval (CI) 0.27–0.51, P < 0.001]. Among 360 RAS patients undergone renal revascularization from eight studies, baseline and post-intervention pooled mean LV mass index values were 129.0 ± 10.2 g/m2 and 115.5 ± 9.9 g/m2, respectively, the standard mean difference being−0.36 ± 0.06 (95% CI from −0.47 to −0.25, P < 0.001). These findings were unaffected by publication bias or single study effect.Our meta-analysis indicates that RAS patients have an increased likelihood of LVH compared with essential hypertensive counterparts and renal artery revascularization has a beneficial effect on LV structure, as reflected by a significant decrease in LV mass index.