This review has been concerned with a general review of the hypertrophy process and its evolution into either physiological or pathological hypertrophy. The constellation of factors which determine the course of the hypertrophy process are essentially a combination of four major determinants; the degree of ventricular wall stress, the duration of such stress, and the nature of the inciting stimulus, as well as the species, age, and health of the animal. The indices, myosin ATPase activity and velocity of muscle shortening, used to distinguish the two types of hypertrophy, have been studied more extensively than other criteria at this time. Future studies may, however, reveal new parameters which will further correlate with the known data, making it easier to understand the evolution of physiological vs. pathological hypertrophy. The evolution of hypertrophy, the parameters affecting its development into either physiological or pathological hypertrophy, and the indices used to distinguish the two types of hypertrophy are presented in this review as initial developments in unification of this complicated subject.