Autophagy played a crucial role for survival when cells were suffering from nutrient deprivation, as autophagy could engulf and degenerate macromolecules to provide new nutrients and energy. Autophagy also plays an essential role in maintaining cellular homeostasis, which was activated in response to the cellular stresses in hypertensive heart disease. Interestingly, many studies had proven that the baseline and up-regulation of autophagy played a beneficial role in myocardial hypertrophy while other studies found that up-regulated autophagy was associated with myopathies. In this review, we showed the signalling pathways which were involved in myocardial hypertrophy. Besides, we talked about the protective as well as harmful effects of autophagy in myocardial hypertrophy. Finally, we proposed the possible reasons of dual effects of autophagy in hypertrophy, including the degree of the activation, the stage of the disease and the signalling pathways responsible for the activation of autophagy, etc.