Abstract The heart responds to increased hemodynamic stress by increased cardiac myocyte size, enhanced protein synthesis and altered gene expression. Regulation of hypertrophic adaptation involves a number of neural and hormonal factors, which act on the cardiovascular system. The aim of the present study was to elucidate the regulation of gene expression of natriuretic peptides and adrenomedullin (AM) in cardiac overload in vivo. Furthermore, the interactions of AM and angiotensin II (Ang II) in cardiac function and development of left ventricular hypertrophy were studied both in vivo and in vitro. The effects of cardiac hypertrophy on the regulation of natriuretic peptides (atrial natriuretic peptide, ANP and B-type natriuretic peptide, BNP) and AM gene expression were studied during pressure overload in the hearts of two hypertensive rat strains, angiotensinogen-renin transgenic rats and spontaneously hypertensive rats as well as their normotensive control strains. Increased workload resulted in rapid upregulation of both BNP and AM gene expression in all rat strains; the response of AM was, however, augmented in hypertensive rats. Direct left ventricular wall stretch induced AM gene expression in isolated, perfused rat hearts, whereas stretching of cultured cardiac myocytes downregulated AM mRNA levels. In cultured cardiac cells exposed to Ang II, endothelin-1 or the α-agonist phenylephrine, Ang II-induced myocyte hypertrophy was selectively inhibited by AM. In vivo, AM interacted with Ang II in circulation by attenuating the hypertensive effects of Ang II, and in the heart by augmenting the Ang II-induced improvement in cardiac systolic function. However, AM had no direct modulatory effects on Ang II-induced left ventricular hypertrophy. These results show that cardiac wall stretch is a major stimulus for the early induction of AM gene expression in both normal and hypertrophied ventricle, and the response in hypertrophied myocardium is augmented. Furthermore, cardiac non-muscle cells may be involved in mediating effects of direct stretch. In vitro, AM acts as a selective inhibitor of Ang II-induced myocyte hypertrophy, suggesting a cardioprotective role for AM to counteract the local renin-angiotensin system and Ang II in cardiac hypertrophy and heart failure. Circulating AM appears to act mainly as a regulator of vascular tone and cardiac function.