Sarcoplasmic reticulum is a principal subcellular organelle which regulates calcium homeostasis, protein synthesis, and apoptosis of cardiomyocytes. Endoplasmic reticulum (ER) stress is defined as the perturbation of ER function which is caused by the alterations in the ER environment, such as the perturbation of Ca(2+) homeostasis, elevated protein synthesis, the deprivation of glucose, altered glycosylation, and the accumulation of misfolded proteins. Moderate ER stress is able to restore cellular homeostasis, i.e., to exert a compensatory effect on cardiomyocytes. However, intense or persistent ER stress may cause ER stress-induced apoptosis, which shifts the hypertrophied myocardium to failure, and affects the pathogenesis and development of myocardial hypertrophy. The article reviewed the role of ER stress response in the pathogenesis and development of myocardial hypertrophy.