Background-Hypertrophic cardiomyopathy (HCM), the most common cause of sudden cardiac death in the young, is characterized by cardiac hypertrophy, myocyte disarray, and interstitial fibrosis. We propose that hypertrophy and fibrosis are secondary to the activation of trophic and mitotic factors and, thus, potentially reversible. We determined whether the blockade of angiotensin II, a known cardiotrophic factor, could reverse or attenuate interstitial fibrosis in a transgenic mouse model of human HCM. Methods and Results-We randomized 24 adult cardiac troponin T (cTnT-Q 92 ) mice, which exhibit myocyte disarray and interstitial fibrosis, to treatment with losartan or placebo and included 12 nontransgenic mice as controls. The mean dose of losartan and the mean duration of therapy were 14.2Ϯ5.3 mg · kg -1 · d -1 and 42Ϯ9.6 days, respectively. Mean age, number of males and females, and heart/body weight ratio were similar in the groups. Collagen volume fraction and extent of myocyte disarray were increased in the cTnT-Q 92 mice (placebo group) compared with nontransgenic mice (9.9Ϯ6.8% versus 4.5Ϯ2.2%, Pϭ0.01, and 27.6Ϯ10.6% versus 3.9Ϯ2.3%, PϽ0.001, respectively). Treatment with losartan reduced collagen volume fraction by 49% to 4.9Ϯ2.9%. The expression of collagen 1␣ (I) and transforming growth factor-1, a mediator of angiotensin II profibrotic effect, were also reduced by 50%. Losartan had no effect on myocyte disarray. Conclusions-Treatment with losartan reversed interstitial fibrosis and the expression of collagen 1␣ (I) and transforming growth factor-1 in the hearts of cTnT-Q 92 mice. These findings suggest that losartan has the potential to reverse or attenuate interstitial fibrosis, a major predictor of sudden cardiac death, in human patients with HCM. Key Words: cardiomyopathy Ⅲ fibrosis Ⅲ collagen Ⅲ death, sudden H ypertrophic cardiomyopathy (HCM), the most common cause of sudden cardiac death (SCD) in the young, 1 is caused by mutations in sarcomeric proteins. 2 It is clinically diagnosed by unexplained cardiac hypertrophy and pathologically by myocyte hypertrophy, disarray, and interstitial fibrosis. 3 Hypertrophy and fibrosis are the major determinants of mortality, morbidity, and SCD 4,5 in HCM and in all acquired forms of cardiac diseases.The genetic basis of HCM has been elucidated, and research efforts are being directed to decipher its molecular pathogenesis and to determine the reversibility of the phenotypes. We previously proposed that interstitial fibrosis, like cardiac hypertrophy, occurs "secondary" to the activation of trophic and mitotic factors in the heart 6 and, thus, is potentially reversible by blocking cardiotrophic factors such as angiotensin II (Ang II). However, despite the well-established role of Ang II blockers in the attenuation of cardiac hypertrophy and fibrosis in acquired cardiac diseases, they are not conventionally used in the treatment of patients with HCM, a genetic paradigm of cardiac hypertrophy and fibrosis. We determined the effects of blocking Ang II on the int...