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Hypertrophy

Hypertrophy refers to the enlargement of an organ or tissue resulting from an increase in the size of its individual cells, rather than an increase in cell number, which is known as hyperplasia.^[1] This adaptive response can be physiological, occurring in response to normal demands such as exercise, pregnancy, or developmental growth, leading to enhanced function without harm. For instance, skeletal muscle hypertrophy develops through resistance training, increasing muscle fiber cross-sectional area to improve strength and performance.^[2] Similarly, during pregnancy, the uterus undergoes physiological hypertrophy to accommodate fetal growth, reverting postpartum without pathology.^[3] In athletes, cardiac hypertrophy from endurance or isometric exercise enhances heart capacity while maintaining normal function.^[4] In contrast, pathological hypertrophy arises from chronic stress or disease, often impairing organ function and progressing to failure if untreated. Common examples include left ventricular hypertrophy in the heart, where high blood pressure causes thickening of the ventricular wall, reducing pumping efficiency and raising risks of arrhythmias or heart failure.^[5] Other instances occur in conditions like hypertrophic cardiomyopathy, a genetic disorder leading to abnormal myocardial thickening that obstructs blood flow.^[6] Pathological forms are typically maladaptive, involving fibrosis and altered gene expression, distinguishing them from beneficial physiological changes.^[4] Key mechanisms driving hypertrophy include mechanical overload, hormonal signals (e.g., insulin-like growth factor-1), and cellular pathways like the PI3K/Akt/mTOR route, which promote protein synthesis and inhibit degradation.^[2] Understanding these processes is crucial for therapeutic interventions, such as exercise regimens to induce beneficial hypertrophy or medications to regress harmful forms.^[7]

Definition and Overview

Definition

Hypertrophy refers to the increase in the size of an organ or tissue through the enlargement of its individual cells, without a corresponding increase in cell number, distinguishing it from other growth processes like hyperplasia.^[1] This adaptive or maladaptive response allows tissues to meet heightened functional demands or compensate for stress, occurring in various biological contexts such as organ regeneration or chronic loading.^[8] The term "hypertrophy" derives from the Greek words hyper (meaning "excess" or "over") and trophē (meaning "nourishment"), reflecting the concept of excessive cellular growth or nourishment.^[8] It was defined in modern medical pathology by Rudolf Virchow in his seminal 1858 work Cellular Pathology, where he differentiated it from related cellular changes.^[9] At its core, hypertrophy involves a net positive balance where protein synthesis outpaces protein degradation within cells, leading to expanded cellular volume and overall tissue mass.^[10] A classic example is liver hypertrophy following partial hepatectomy, where the remaining hepatocytes enlarge to restore organ function before full regeneration occurs.^[11] Quantitatively, hypertrophy is often assessed by relative organ weight, calculated as the ratio of organ mass to body weight, providing a standardized measure of enlargement independent of overall body size.^[12] Hypertrophy can manifest as physiological, serving adaptive purposes like enhanced workload capacity, or pathological, arising from disease states such as hypertension, though both share the fundamental cellular mechanism of size increase.^[1] Hypertrophy is fundamentally distinct from hyperplasia, the latter being an adaptive process involving an increase in tissue mass through proliferation and an elevated number of cells, whereas hypertrophy achieves growth via enlargement of existing cells without altering their count.^[13] Although both can coexist and contribute to organ enlargement in response to stimuli like hormonal influences or mechanical stress, their mechanisms diverge: hyperplasia relies on mitotic cell division, while hypertrophy emphasizes intracellular accumulation of proteins, organelles, and myofibrils.^[14] Atrophy presents the converse of hypertrophy, manifesting as a decrease in cell and organ size due to accelerated protein degradation that outpaces synthesis, commonly triggered by disuse, ischemia, or denervation.^[15] In atrophying cells, ubiquitin-proteasome pathways and autophagy dominate, leading to dismantling of structural components like myofibrils and mitochondria, in stark contrast to the anabolic, synthetic dominance in hypertrophic cells.^[10] Unlike these quantitative changes in cell size or number, metaplasia entails a qualitative shift where one differentiated cell type is replaced by another within the same tissue, serving as an adaptive response to persistent irritation or altered environmental cues.^[16] This transformation, often reversible, does not involve alterations in cell dimensions but rather a reprogramming of cellular phenotype to better withstand stress. Hypertrophy frequently functions in an adaptive capacity as a compensatory mechanism to accommodate heightened workload or functional demands, enabling tissues to sustain performance without relying on cell proliferation.^[13]

Types of Hypertrophy

Physiological Hypertrophy

Physiological hypertrophy represents an adaptive, non-pathological enlargement of cells or tissues in response to increased functional demands, characterized by reversible growth that enhances organ efficiency without compromising health. This process involves the expansion of individual cell size, primarily through increased protein synthesis and organelle proliferation, allowing tissues to better meet physiological needs such as heightened workload or volume requirements. Unlike hyperplastic growth, which adds new cells, physiological hypertrophy maintains cell number while optimizing performance in healthy individuals.^[4] A prominent example occurs in skeletal muscle, where resistance training stimulates hypertrophy, resulting in greater cross-sectional area and contractile capacity to support enhanced physical activity. In this context, mechanical overload from exercises like weightlifting triggers muscle fiber enlargement, enabling athletes to generate more force and sustain prolonged efforts. Similarly, during pregnancy, the uterus experiences physiological hypertrophy driven by estrogen and mechanical stretch, expanding from approximately 70 grams to over 1,100 grams to accommodate fetal development and maintain maternal-fetal circulation.^[2]^[17] The benefits of physiological hypertrophy are evident in improved organ function tailored to specific demands; for instance, in endurance or strength athletes, skeletal muscle growth augments power output and fatigue resistance, while cardiac hypertrophy—known as athlete's heart—increases stroke volume and overall cardiac output to support elevated aerobic capacity. These adaptations promote superior performance and metabolic efficiency without long-term detriment.^[18]^[19] This form of hypertrophy is typically reversible upon removal of the inducing stimulus, ensuring tissue homeostasis. In skeletal muscle, detraining leads to gradual atrophy, with muscle mass declining as training ceases, often within weeks to months depending on prior adaptation level.^[20] Likewise, postpartum uterine involution facilitates rapid regression of hypertrophy, restoring the uterus to near pre-pregnancy dimensions through apoptosis and tissue remodeling within 4-6 weeks. Cardiac adaptations in athletes also regress with prolonged detraining, as evidenced by reductions in left ventricular mass after 1 month of complete detraining.^[17]^[21]

Pathological Hypertrophy

Pathological hypertrophy is characterized by the maladaptive enlargement of cells or tissues in response to chronic disease-related stressors, potentially leading to irreversible structural changes and progressive organ dysfunction if untreated, distinguishing it from the reversible, beneficial adaptations seen in physiological hypertrophy.^[22] This process involves excessive protein synthesis and sarcomere reorganization, often triggered by sustained hemodynamic overload or hormonal imbalances, leading to a shift toward fetal gene expression patterns that impair normal cellular function. However, early treatment of the underlying cause can promote regression of pathological hypertrophy in some cases.^[23]^[24] Common causes include chronic pressure overload from conditions such as hypertension or aortic valvular stenosis, volume overload from mitral regurgitation, and endocrine disorders like acromegaly, where excess growth hormone and insulin-like growth factor-1 drive widespread tissue enlargement.^[24]^[25] In the renal system, unilateral renal artery stenosis can induce compensatory hypertrophy in the contralateral kidney as an initial adaptive response that becomes pathological over time due to persistent ischemia.^[26] The consequences of pathological hypertrophy include increased tissue stiffness, reduced compliance, and heightened susceptibility to fibrosis and programmed cell death via apoptosis, which collectively contribute to organ failure, such as heart failure in cardiac cases or progressive renal insufficiency.^[23] For instance, in the heart, this manifests as concentric hypertrophy from pressure overload, promoting interstitial fibrosis and arrhythmogenic risk, whereas eccentric patterns from volume overload exacerbate chamber dilation and systolic dysfunction.^[27] In acromegaly, pathological cardiac hypertrophy often leads to diastolic impairment and increased cardiovascular mortality if untreated.^[25]

Mechanisms of Hypertrophy

Cellular and Molecular Basis

Hypertrophy at the cellular level fundamentally involves an increase in cell size through enhanced protein synthesis and reduced degradation, leading to net accumulation of cellular components. This process is driven by the upregulation of ribosomal biogenesis, which expands the protein synthetic machinery to support higher rates of translation. For instance, the proliferation of ribosomes allows cells to produce more myofibrillar proteins, such as actin and myosin, which are essential structural elements in muscle cells. Additionally, hypertrophy is characterized by the proliferation of organelles, including mitochondria, to meet the increased energy demands of enlarged cells. This organelle expansion ensures that cellular metabolism can sustain the growth without compromising function. Molecular triggers for hypertrophy include mechanical stimuli like stretch and biochemical signals from hormones and growth factors. Mechanical stretch on cell membranes activates mechanosensitive ion channels, leading to calcium influx that influences downstream cellular responses. Hormones such as insulin-like growth factor 1 (IGF-1) and growth factors bind to cell surface receptors, initiating cascades that activate transcription factors like nuclear factor of activated T-cells (NFAT). NFAT translocation to the nucleus promotes the expression of genes involved in hypertrophy, such as those encoding hypertrophy-associated proteins. These triggers ensure that hypertrophy is a coordinated response to environmental cues, maintaining cellular homeostasis. The balance of protein turnover is central to hypertrophy, where net protein accretion is determined by the equation: net protein accretion = protein synthesis rate - protein degradation rate. During hypertrophy, this balance shifts favorably through accelerated synthesis and suppressed degradation. A key mechanism for reducing degradation involves inhibition of the ubiquitin-proteasome system (UPS), the primary pathway for protein breakdown in cells. UPS inhibition prevents the tagging and degradation of contractile proteins, allowing their accumulation and contributing to cell enlargement. This regulated proteostasis is crucial for the sustained growth observed in hypertrophic responses. Hypertrophy also entails shifts in cellular energy metabolism to support biosynthetic demands. In many cases of hypertrophy, cells exhibit increased glycolytic activity (aerobic glycolysis), providing biosynthetic precursors and rapid ATP to support growth, while oxidative metabolism may also adapt to meet energy demands.^[28] This metabolic reprogramming is modulated by AMP-activated protein kinase (AMPK), which senses energy status and adjusts metabolic flux accordingly. When activated, AMPK promotes catabolic processes but can be inhibited during hypertrophy to favor anabolic pathways, ensuring sufficient energy for protein synthesis and organelle biogenesis.

Key Signaling Pathways

The mammalian target of rapamycin (mTOR) pathway functions as a central regulator of protein synthesis during hypertrophic responses across various tissues, including skeletal and cardiac muscle.^[29] Activated by anabolic stimuli such as amino acids (e.g., leucine) and mechanical loading, mTOR complex 1 (mTORC1) phosphorylates downstream targets like S6 kinase 1 (S6K1) and 4E-binding protein 1 (4E-BP1), thereby enhancing ribosomal biogenesis and translation initiation to support cellular enlargement.^[30] In growth factor signaling, insulin-like growth factor 1 (IGF-1) initiates the pathway through phosphoinositide 3-kinase (PI3K), which recruits and activates Akt (also known as protein kinase B). Akt then phosphorylates tuberous sclerosis complex 2 (TSC2) at multiple sites (e.g., Ser939, Thr1462), inhibiting its GTPase-activating protein (GAP) function toward Ras homolog enriched in brain (Rheb); this allows Rheb-GTP accumulation and subsequent mTORC1 activation on lysosomes.^[31] Genetic or pharmacological blockade of mTOR, such as with rapamycin, prevents hypertrophy induced by overload or IGF-1 in rodent models, underscoring its essential role.^[29] The calcineurin-nuclear factor of activated T-cells (NFAT) pathway represents a key calcium-sensitive cascade in hypertrophy, particularly in response to mechanical stress or neurohormonal signals.^[32] Upon elevation of intracellular calcium levels, calmodulin binds and activates the phosphatase calcineurin, which dephosphorylates NFAT transcription factors (e.g., NFATc1, NFATc3), promoting their nuclear translocation and cooperation with other factors like GATA-2 to induce expression of hypertrophic genes, including the fetal gene program (e.g., atrial natriuretic factor, β-myosin heavy chain). This pathway is implicated in both physiological and pathological hypertrophy; for instance, transgenic overexpression of activated calcineurin in cardiomyocytes triggers rapid hypertrophic growth reversible by cyclosporine A, a calcineurin inhibitor.^[32] In skeletal muscle, calcineurin-NFAT signaling similarly drives fiber-type switching and hypertrophy in response to chronic loading.^[33] The mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway contributes to hypertrophic gene transcription, especially under stress conditions like pressure overload or angiotensin II stimulation.^[34] This cascade begins with ligand binding to receptor tyrosine kinases or G-protein-coupled receptors, activating Ras, which recruits Raf kinase to phosphorylate and activate mitogen-activated protein kinase kinase (MEK1/2); MEK then dual-phosphorylates ERK1/2 (Thr202/Tyr204), enabling ERK nuclear entry and phosphorylation of targets such as Elk-1 and GATA4 to upregulate immediate-early genes (e.g., c-fos, c-jun) and sarcomeric proteins. Sustained ERK activation correlates with adaptive hypertrophy in transgenic models overexpressing MEK1, enhancing contractility without fibrosis, though chronic activation can shift toward maladaptive remodeling.^[34] These pathways integrate through cross-talk to fine-tune hypertrophic responses; notably, IGF-1 stimulates both mTOR via PI3K/Akt and calcineurin-NFAT signaling, as evidenced by IGF-1-induced myocyte hypertrophy requiring calcineurin activity for NFAT/GATA-2-mediated transcription alongside mTOR-dependent protein synthesis.^[33] ERK can intersect with mTOR by phosphorylating TSC2, further amplifying anabolic outputs under combined growth and stress cues.^[30] This convergence allows coordinated regulation, where pathway balance determines whether hypertrophy remains physiological or progresses to pathology.^[35]

Applications in Specific Tissues

Skeletal Muscle Hypertrophy

Skeletal muscle hypertrophy is the enlargement of skeletal muscle fibers, primarily driven by resistance exercise, resulting in increased muscle cross-sectional area (CSA) and force production capacity. This process exemplifies physiological hypertrophy, where adaptations enhance performance without pathological consequences. It occurs mainly in type II (fast-twitch) fibers but can affect type I fibers to a lesser extent, supporting greater overall muscle mass and strength.^[36] The primary mechanism of skeletal muscle hypertrophy involves the addition of contractile myofibrils within existing muscle fibers. Myofibrils increase in number (parallel addition) to expand fiber diameter, thereby boosting CSA and strength, or in series to accommodate length changes during growth. This protein accretion outpaces degradation, driven by mechanical tension from loading, which activates mechanosensors like integrins and focal adhesion kinase to initiate signaling for protein synthesis. Satellite cell fusion contributes new myonuclei to support this expansion, particularly in sustained or high-volume training, but plays a minimal direct role in initial size gains, as hypertrophy can proceed via domain expansion of existing nuclei.^[37]^[38]^[39] Key stimuli for skeletal muscle hypertrophy include resistance training employing progressive overload, where loads are incrementally increased to challenge muscle fibers beyond their current capacity. This elicits mechanical tension, metabolic stress, and minor muscle damage, all promoting hypertrophic signaling. Hormonal factors, notably testosterone, amplify these responses by binding androgen receptors in muscle cells, enhancing protein synthesis and satellite cell activity without requiring new myonuclear addition in early phases.^[36]^[40] Two distinct types of skeletal muscle hypertrophy are recognized: myofibrillar and sarcoplasmic. Myofibrillar hypertrophy emphasizes growth in contractile proteins (actin and myosin), leading to denser myofibrils and greater strength gains, typically from heavy-load training (e.g., 70-85% of one-repetition maximum). In contrast, sarcoplasmic hypertrophy involves expansion of the sarcoplasm—the fluid-filled compartment containing glycogen, mitochondria, and non-contractile proteins—potentially enhancing endurance and metabolic capacity, often observed in higher-repetition schemes. While both contribute to overall size, evidence suggests myofibrillar changes predominate in most training contexts, with sarcoplasmic adaptations being less pronounced and context-specific.^[41] Measurement of skeletal muscle hypertrophy focuses on changes in fiber or whole-muscle CSA, assessed non-invasively via magnetic resonance imaging (MRI) or ultrasound for accuracy and reliability, or invasively through muscle biopsy to quantify individual fiber dimensions. In novice trainees, resistance training can yield notable early gains, with quadriceps CSA increasing by approximately 5-10% over the first few months, reflecting rapid neural and structural adaptations before plateauing. These metrics establish the scale of adaptation, with longitudinal studies confirming progressive improvements tied to training volume and intensity.^[42]

Cardiac Muscle Hypertrophy

Cardiac muscle hypertrophy, or left ventricular hypertrophy (LVH), represents an adaptive response of the heart to increased hemodynamic stress, primarily involving enlargement of cardiomyocytes to maintain cardiac output. This process is classified into two main types based on the underlying stimulus and resulting geometry: concentric and eccentric hypertrophy. Concentric hypertrophy occurs in response to pressure overload, such as in chronic hypertension or aortic stenosis, leading to thickening of the ventricular walls without significant chamber dilation; this remodeling normalizes systolic wall stress by increasing wall thickness relative to chamber radius.^[43] In contrast, eccentric hypertrophy develops under volume overload conditions, like mitral or aortic regurgitation, resulting in chamber dilation and proportional wall thickening to accommodate increased preload and reduce diastolic wall stress.^[44] These adaptations initially preserve cardiac function but can predispose the heart to maladaptive changes over time. At the pathophysiological level, cardiac hypertrophy involves the re-expression of a fetal gene program, characterized by upregulation of genes such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which are markers of the hypertrophic response and help regulate fluid balance and vascular tone.^[45] This molecular shift, triggered by mechanical stress and neurohormonal activation, supports initial compensatory growth but can progress to decompensation. A key mechanism in this transition to heart failure is increased cardiomyocyte apoptosis, where oxidative stress and downregulation of survival signaling pathways lead to myocyte loss, fibrosis, and ventricular dilation, ultimately impairing contractility.^[46] Studies in pressure-overload models demonstrate that apoptotic rates rise during the shift from compensated hypertrophy to failure, contributing to reduced myocyte number and systolic dysfunction.^[47] Risk factors for cardiac hypertrophy include aging, which promotes structural remodeling through cumulative hemodynamic and inflammatory changes, and obesity, which exacerbates load via hypertension, insulin resistance, and direct lipotoxic effects on cardiomyocytes.^[48] Epidemiological data indicate a prevalence of LVH in 20-40% of hypertensive patients, with higher rates in those with uncontrolled blood pressure or comorbidities like obesity, underscoring the role of modifiable factors in disease progression.^[49] Long-term outcomes of untreated hypertrophy often involve initial compensation for workload through enhanced contractility, but progression to diastolic dysfunction is common, where impaired relaxation and increased stiffness limit ventricular filling, elevating risks for heart failure with preserved ejection fraction.^[50] This diastolic impairment correlates with adverse events like arrhythmias and sudden death.^[51]

Hypertrophy in Other Organs

Hypertrophy in the liver serves as an initial regenerative mechanism following partial hepatectomy or resection, where the remaining hepatic tissue undergoes transient compensatory enlargement to support subsequent restoration of organ mass and function. This process begins with hypertrophy (enlargement) of hepatocytes, followed primarily by hyperplasia (proliferation), driven by the rapid upregulation of hepatocyte growth factor (HGF), a potent mitogen produced by nonparenchymal cells such as hepatic stellate cells and endothelial cells shortly after injury. HGF binds to its receptor c-Met on hepatocytes, initiating signaling cascades that promote DNA synthesis and cell growth, thereby facilitating the adaptive response to maintain liver homeostasis.^[52]^[53] In the kidney, hypertrophy occurs as a compensatory adaptation after unilateral nephrectomy, leading to enlargement of the remnant kidney's glomeruli and tubules to handle increased filtration load. This involves hyperplasia and hypertrophy of tubular epithelial cells, initially preserving renal function, but can progress to pathological states like glomerular sclerosis and tubulointerstitial fibrosis if sustained. In diabetic nephropathy, hyperglycemia further exacerbates renal hypertrophy through mechanisms including mesangial expansion and thickening of the glomerular basement membrane, ultimately contributing to sclerosis and declining kidney function.^[54]^[55] Prostate hypertrophy is a prominent feature of benign prostatic hyperplasia (BPH), a common age-related condition characterized by the non-malignant enlargement of prostate glandular and stromal tissues, often driven by androgens. Androgen receptor signaling, particularly via dihydrotestosterone, promotes the proliferation and hypertrophy of prostate epithelial and stromal cells, with evidence showing that individuals with androgen deficiencies, such as those castrated prepubertally, do not develop BPH. This androgen-dependent process underlies the progressive growth that can obstruct urinary flow, though estrogens may also play a permissive role in modulating the response.^[56]^[57] Endocrine organs also exhibit hypertrophy in response to specific stressors. In the thyroid, iodine deficiency triggers compensatory hypertrophy and hyperplasia of follicular cells, stimulated by elevated thyroid-stimulating hormone (TSH) levels that attempt to enhance iodide uptake and thyroid hormone synthesis, resulting in endemic goiter. Similarly, the adrenal glands can undergo hypertrophy under acute or chronic stress, involving enlargement of the zona fasciculata and reticularis due to adrenocorticotropic hormone (ACTH) overstimulation, which boosts cortisol production; this response is often reversible upon stress resolution and may include both hyperplastic and hypertrophic components in a region-specific manner.^[58]^[59]

Clinical and Research Aspects

Diagnosis and Measurement

Diagnosis and measurement of hypertrophy involve a combination of non-invasive imaging, biomarker analysis, functional tests, and invasive procedures to detect and quantify tissue enlargement in clinical and research contexts. In cardiac hypertrophy, echocardiography serves as a primary imaging modality, enabling the calculation of left ventricular mass index (LVMI) through 2D or M-mode measurements of wall thickness and chamber dimensions, with LVMI values exceeding 115 g/m² in men and 95 g/m² in women indicating left ventricular hypertrophy (LVH).^[51] This technique provides real-time assessment of hypertrophy patterns and is recommended by guidelines for initial evaluation due to its accessibility and ability to differentiate physiological from pathological changes.^[60] For skeletal muscle hypertrophy, magnetic resonance imaging (MRI) is considered the gold standard for quantifying muscle volume and cross-sectional area (CSA), offering precise volumetric analysis without radiation exposure and high reproducibility for tracking changes over time.^[61] Biomarkers play a supportive role in detecting and monitoring hypertrophy, particularly in cardiac cases. Elevated levels of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) in serum indicate myocardial stress and correlate with hypertrophy severity and clinical outcomes in conditions like hypertrophic cardiomyopathy (HCM).^[62] Similarly, high-sensitivity troponin I or T elevations reflect myocyte injury associated with pathological cardiac hypertrophy, aiding in risk stratification alongside imaging.^[63] For cellular-level verification across tissues, muscle biopsy remains essential, involving histological analysis to measure fiber diameter or CSA, where increases in mean fiber size confirm hypertrophic remodeling; semi-automated tools enhance accuracy in quantifying these parameters from cross-sections.^[64] Functional assessments complement structural evaluations, with electrocardiography (ECG) providing indirect evidence of cardiac hypertrophy through voltage criteria. Common ECG indices for LVH include the Sokolow-Lyon criterion (S wave in V1 plus R wave in V5 or V6 >35 mm) and Cornell voltage criteria (S in V3 plus R in aVL >28 mm in men or >20 mm in women), which detect increased electrical forces from thickened myocardium, though sensitivity varies (around 20-50%) compared to imaging.^[65] In research settings, animal models facilitate controlled studies of hypertrophy induction and progression. The transverse aortic constriction (TAC) model in mice or rats creates pressure overload to mimic cardiac hypertrophy, allowing longitudinal assessment of ventricular remodeling via echocardiography or histology, and is widely used to evaluate molecular mechanisms and therapeutic targets.^[66] These methods collectively enable precise diagnosis and quantification, tailored to specific tissues such as cardiac or skeletal muscle.

Therapeutic Implications

Pharmacological interventions play a central role in managing pathological hypertrophy, particularly in the cardiac context. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have demonstrated efficacy in regressing left ventricular hypertrophy (LVH) by interrupting the renin-angiotensin-aldosterone system, which contributes to myocyte growth and fibrosis.^[67] Clinical evidence from meta-analyses shows that ACE inhibitors like ramipril not only regress ECG-detected LVH but also prevent its progression in hypertensive patients with controlled blood pressure.^[68] Similarly, ARBs such as losartan reduce left ventricular mass beyond blood pressure lowering alone, with studies indicating superior reversal of LVH compared to other antihypertensives.^[69] Beta-blockers, including propranolol and metoprolol, mitigate hypertrophy by reducing cardiac load and heart rate, thereby alleviating pressure overload and improving diastolic filling in conditions like hypertrophic cardiomyopathy.^[70] These agents also suppress endoplasmic reticulum stress and attenuate hypertrophic signaling, leading to decreased fibrosis and enhanced cardiac function.^[71] Lifestyle modifications offer non-pharmacological strategies to influence hypertrophy, emphasizing the promotion of physiological adaptations over pathological ones. Structured exercise protocols, such as aerobic training, induce physiological cardiac hypertrophy characterized by improved contractility and capillary density without fibrosis, contrasting with the maladaptive remodeling in pressure overload states.^[4] Resistance and endurance exercises can shift hypertrophic responses toward beneficial pathways by activating PI3K/Akt signaling while inhibiting pathological calcineurin-NFAT activation, as evidenced in animal models and human athletes.^[72] Emerging therapies aim to target molecular drivers of hypertrophy with greater specificity. Gene therapy approaches inhibiting mTORC1 via PRAS40 overexpression have shown promise in preclinical models, ameliorating pathological cardiac hypertrophy by reducing protein synthesis and fibrosis without impairing physiological growth.^[73] Similarly, strategies modulating calcineurin signaling, such as through myocyte-enriched calcineurin-interacting protein (MCIP1) delivery, block hypertrophic gene expression in response to stress signals, offering potential for targeted intervention in heart failure models.^[74] Histone deacetylase (HDAC) inhibitors, like those targeting HDAC5, are under investigation for their role in reversing vascular and cardiac hypertrophy by altering epigenetic regulation of pro-hypertrophic genes, with preclinical studies from the early 2020s demonstrating reduced myocyte size and inflammation in angiotensin II-induced models.^[75] As of 2025, recent preclinical research has highlighted HDAC6 inhibitors for preventing pathological cardiac hypertrophy and HDAC2 down-regulation for mitigating ventricular arrhythmias in pressure overload models.^[76]^[77] Clinical trials in the 2020s have explored HDAC inhibitors primarily in oncology but are expanding to cardiovascular applications, showing anti-fibrotic effects in related inflammatory conditions.^[78] Prognosis in hypertrophy-related conditions improves markedly with early intervention, particularly through blood pressure control to halt progression to heart failure. Intensive systolic blood pressure lowering to below 120 mmHg reduces the incidence of new LVH by up to 25-30% and slows progression in existing cases, as demonstrated in large trials like SPRINT.^[79] In patients with malignant LVH, such strategies prevent acute decompensated heart failure and mortality, yielding absolute risk reductions of approximately 2-5% over standard care.^[80] Overall, timely management via antihypertensives and lifestyle changes can decrease cardiovascular event risk by 40-60% in hypertensive LVH cohorts, underscoring the value of proactive therapy.^[81]

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[43]
Myocardial stress and hypertrophy: a complex interface between ...
Concentric hypertrophy reduces systolic wall stress in pressure overload, and eccentric hypertrophy reduces diastolic wall stress in volume overload (dashed red ...
[44]
Cardiac remodelling: concentric versus eccentric hypertrophy in ...
Due to an increased dynamic load, the heart of the endurance athlete responds predominantly with eccentric hypertrophy. Endurance-trained hearts are subject to ...
[45]
natriuretic peptides during development of the fetal heart ... - PubMed
The reappearance of ventricular ANP expression in adults is recognized as a marker of the induction of the embryonic gene program in ventricular hypertrophy.
[46]
Downregulation of survival signalling pathways and ... - PubMed
Downregulation of survival signalling pathways and increased apoptosis in the transition of pressure overload-induced cardiac hypertrophy to heart failure.
[47]
Increased cardiomyocyte apoptosis and changes in proapoptotic ...
These data suggest that in response to chronic pressure overload, cardiomyocyte-specific apoptosis contributed to the transition from LVH to LVD.
[48]
Obesity Induces Signs of Premature Cardiac Aging in ... - JACC
Jan 26, 2011 · Obesity is associated with an increased incidence of left ventricular hypertrophy, diastolic dysfunction, heart failure, and atherosclerosis.
[49]
Left Ventricular Hypertrophy and Clinical Outcomes in Hypertensive ...
Its prevalence ranges from 20% in mildly hypertensive patients to almost 100% in those with severe or complicated HT.Abstract · LVH in Hypertensive Patients · Role of Antihypertensive...
[50]
Left Ventricular Hypertrophy | Circulation
... diastolic heart failure. The cornerstone of treatment of hypertrophic heart disease with diastolic dysfunction, progressive systolic dysfunction, or both is ...
[51]
Left Ventricular Hypertrophy - StatPearls - NCBI Bookshelf - NIH
Left ventricular hypertrophy (LVH) is an increase in left ventricular mass due to increased wall thickness, cavity enlargement, or both.<|separator|>
[52]
Liver Regeneration and the Atrophy-Hypertrophy Complex - PMC
Hepatocyte growth factor (HGF) is a potent mitogen that binds the HGF receptor, c-met, and can induce hepatocyte DNA synthesis both in vitro and in vivo. HGF is ...
[53]
Markers of liver regeneration—the role of growth factors and cytokines
Feb 12, 2020 · Three hours after resection, new HGFs are produced by the HSCs and ECs. The proliferative phase starts 5 h after resection and can be divided ...
[54]
Physiology and Pathophysiology of Compensatory Adaptations of a ...
Endothelial dysfunction promotes the transition from compensatory renal hypertrophy to kidney injury after unilateral nephrectomy in mice. Am. J. Physiol. Renal ...
[55]
Acute Kidney Injury and Progression of Diabetic Kidney Disease
Mar 1, 2019 · DN is characterized by glomerular basement membrane (GBM) thickening, mesangial expansion, nodular glomerular sclerosis, and tubulointerstitial ...
[56]
Androgens and estrogens in benign prostatic hyperplasia
This article will review the BPH literature and consider the widely accepted permissive role of androgens and the emerging importance of estrogens in BPH.
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Benign Prostatic Hyperplasia - StatPearls - NCBI Bookshelf
Men who are castrated before puberty or who have an androgen-related disorder do not develop BPH. Dietary factors also appear to influence the development of ...
[58]
Health Consequences of Iodine Deficiency - PMC - PubMed Central
Dietary iodine deficiency stimulates TSH secretion, which results in thyroid hypertrophy. The enlargement of the thyroid gland due to dietary iodine deficiency ...
[59]
Acute Transient Stress Induced Adrenal Hypertrophy and ... - NIH
Nov 17, 2015 · Adrenal gland hypertrophy can be related to acute stress with abnormal adrenal function tests. It may not always need treatment.
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2020 AHA/ACC Guideline for the Diagnosis and Treatment of ...
Nov 20, 2020 · Comprehensive 2D echocardiography plays a primary role in establishing the diagnosis of HCM, determining hypertrophy pattern, presence of LV ...
[61]
Methodological considerations for and validation of the ...
Jan 6, 2021 · Magnetic resonance imaging (MRI) is the current gold standard for measuring changes in muscle size (cross‐sectional area [CSA] and volume) ...
[62]
Circulating Biomarkers in Hypertrophic Cardiomyopathy
Nov 16, 2022 · Circulating biomarkers in hypertrophic cardiomyopathy that correlate with clinical outcomes include brain natriuretic peptide (BNP), NT‐proBNP ( ...
[63]
Clinical utility of natriuretic peptides and troponins in hypertrophic ...
Sep 1, 2016 · Troponin and BNP correlate with disease severity and symptoms in HCM. •. These markers predict clinical risk independently of established risk ...
[64]
Approach for semi-automated measurement of fiber diameter in ...
This new segmentation tool allows scientists to efficiently analyze large muscle cross-sections for use in research studies and diagnostics.
[65]
The Role of ECG in the Diagnosis of Left Ventricular Hypertrophy - NIH
The electrocardiographic (ECG) diagnostics of left ventricular hypertrophy (LVH) currently is based primarily on the QRS voltage criteria. However ...
[66]
Evaluation of the transverse aortic constriction model in ICR and ...
Nov 28, 2022 · Transverse aortic constriction (TAC) is a frequently used model to investigate pressure overload-induced progressive heart failure (HF); ...
[67]
Angiotensin II receptor blockers and cardiovascular protection
However, the most updated meta-analysis indicates that ARBs, ACE-inhibitors, and calcium antagonists are all more effective in reversing LVH than beta-blockers, ...
[68]
Reduction of Cardiovascular Risk by Regression of ...
This study shows that the ACE inhibitor ramipril causes regression and prevention of ECG-LVH in a broad range of patients with normal or controlled blood ...
[69]
Regression of left ventricular hypertrophy | Hypertension Research
Mar 11, 2024 · More recently, angiotensin receptor-neprilysin inhibitors have been reported to be effective in regressing hypertrophy [5]. Moreover, sodium– ...
[70]
Reduction by oral propranolol treatment of left ventricular ...
It is concluded that propranolol treatment approximately halves the compensatory cardiac hypertrophy occurring in response to a left ventricular pressure over- ...
[71]
β-AR Blockers Suppresses ER Stress in Cardiac Hypertrophy and ...
The preventative effect of β-AR blockers on ER stress is also parallel to the reduction of cardiac hypertrophy and improvement of cardiac function. Moreover ...
[72]
The Fuzzy Logic of Physiological Cardiac Hypertrophy | Hypertension
Mar 26, 2007 · Physiological changes caused by exercise and peptide growth hormone treatment have favorable effects on pathological hypertrophy.
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Hormones, Hypertrophy, and Hype: An Evidence-Guided Primer on ...
An evidence-guided primer on endocrine influences on exercise-induced muscle hypertrophy. Key Words: resistance exercise training, muscle hypertrophy, ...
[74]
Is an Energy Surplus Required to Maximize Skeletal Muscle ...
Various dietary interventions have been proposed to influence muscle hypertrophy, including manipulation of protein intake, specific supplement prescription, ...
[75]
Pathological hypertrophy amelioration by PRAS40-mediated ...
Jul 10, 2013 · In this study we demonstrate the cardioprotective effects of PRAS40-mediated inhibition of mTORC1 using a clinical relevant cardiac gene therapy ...
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Myocyte-enriched calcineurin-interacting protein, MCIP1, inhibits ...
The calcineurin antagonist drugs cyclosporin and FK506 have been observed by several laboratories to block hypertrophic responses of the heart in animal models ...Missing: mTOR | Show results with:mTOR
[77]
Angiotensin II-induced histone deacetylase 5 phosphorylation ...
HDAC5 is an upstream mediator of Egr-1 expression and cell hypertrophy in response to ANG II in vascular smooth muscle cells. INTRODUCTION. The development of ...
[78]
HDAC and HDAC Inhibitor: From Cancer to Cardiovascular Diseases
To date, a great number of HDAC inhibitors are in clinical trials. Four drugs, Vorinostat, Romidepsin, Belinostat, and Panobinostat are already approved by ...Missing: 2020s | Show results with:2020s
[79]
Intensive Blood Pressure Lowering Improves Left Ventricular ...
Jun 1, 2023 · Intensive SBP lowering was associated with a significantly reduced risk of newly developed LVH and slower progression of the mean Peguero-Lo Presti value.
[80]
Intensive Blood Pressure Lowering in Patients With Malignant Left ...
Oct 18, 2022 · Intensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death.
[81]
Effect of Intensive Blood Pressure Lowering on Left Ventricular ...
Taken altogether, intensive BP lowering resulted in lower rates of LVH in the SPRINT trial by reducing the risk of developing new LVH and improving existing LVH ...