Elsewhere in this issue (p 1285), Sparrow et al report that ECG signs suggestive of left ventricular hypertrophy (LVH) might serve as predictors of subsequent hypertension. These epidemiologic observations raise new questions regarding cardiac involvement in hypertension; the latter has recently been a rapidly evolving field. The relationship between hypertension and LVH was usually thought of as a direct response of the heart to a pressure overload. Apparently supporting that viewpoint was the high incidence of LVH in hypertensive patients both at autopsy and in epidemiologic studies, 1 as well as the close correlation found in some models of experimental hypertension between BP level and ventricular weight. More recently, however, evidence has been accumulating, again from both experimental and clinical studies, to the effect that the cardiac response to hypertension was more complex than originally surmised, 2 that it developed early in the evolution of the disease, 3 and that