The author discusses the causes of myocardial ischemia among patients with arterial hyper­tension and left ventricular hypertrophy. Epidemiological data show that 19% of the Slovene population between the ages of 40 and 70 years suffer from arterial hypertension and almost 80% of such patients die due to left ventricular hypertrophy, myocardial ischemia or their consequences. The multifactorial etiology of myocardial ischemia is analysed and discussed systematically and for clinical purposes.