Overweight and hypertension are considered to be independent contributors to the development of left ventricular hypertrophy (LVH). We investigated a selected subgroup (n = 520, aged 52 to 67 years) of participants from the MONICA Augsburg cohort to assess gender-specificity of left ventricular adaptation in response to increasing weight and blood pressure degrees. M-mode-echocardiographic measurements were made and calculated according to the Penn-convention in 293 women and 227 men. LVH was defined as left ventricular mass indexed to height (LVMIm) > 143 g/m in men and > 102 g/m in women (Framingham criteria). Men and women were comparable with regard to increase in LVMIm from the lowest weight and blood pressure group to the highest groups, respectively. In men the increase in LVMIm was 31% from lean to severely obese subjects (111 vs. 145 g/m, p < 0.003) and 25% from normotensive to treated hypertensive subjects (116 vs. 145 g/m, p < 0.0001); in women respective values were 36% (83 vs. 113 g/m, p < 0.0001) and 27% (88 vs. 112 g/m, p < 0.0001). The combined occurrence of obesity and hypertension had an additional effect on left ventricular mass, which was much more pronounced in women than in men. In particular, the increase in LVMIm from the group of lean normotensives to the group of severely obese treated hypertensives was 85% (72 g/m vs. 133 g/m, p < 0.0001) in women and 49% (96 g/m vs. 144 g/m, p < 0.002) in men (p-value for the gender-interaction term < 0.05). The odds ratio for the LVH-prevalence in hypertensive obese subjects as opposed to normal weight normotensive subjects were 11.9 (p < 0.0001) in women and 4.9 (p < 0.0004) in men. In conclusion, we observed for both genders independently and similarly pronounced effects of hypertension and obesity. The combined occurrence of hypertension and obesity had an additional impact on left ventricular mass and hypertrophy, however, in women the effects were significantly more pronounced than in men. The data underscore the effects of hypertension and obesity in the development of LVH. In addition, gender specific factors seem to modulate the effects of these risk factors on left ventricular mass.