Step 1: Match the word to its meaning. The prefix hyper- means excess and -trophy refers to growth or nourishment of an existing cell. So hypertrophy means an existing cell grows larger; it does not make more cells. The answer is increase in cell size.
Step 2: Cellular events. Under a sustained load the cell ramps up production of contractile and structural proteins. Because the cell is often post-mitotic, it cannot divide, so the extra protein simply makes each cell bulkier. DNA content per nucleus may rise as the cell is held in the cycle without splitting.
Step 3: Clinical anchor. Think of an athlete's heart or a weightlifter's skeletal muscle, and the thickened ventricle in hypertension. These are tissues whose cells cannot multiply, so they cope with extra demand by enlarging.
Step 4: Eliminate distractors. More cells equals hyperplasia, fewer cells equals hypoplasia or involution, and smaller cells equals atrophy. Only enlargement of the cell fits hypertrophy.
\[\boxed{\text{Increase in cell size}}\]