Diagnosis of LVH

A 66-year-old African American software engineer with hypertension (diagnosed 2 years ago on his annual exam) is referred to your clinic with newly diagnosed heart failure with preserved ejection fraction (HFpEF). His echocardiogram shows biatrial enlargement, concentric left ventricular hypertrophy (LVH) with a wall thickness of 1.6 cm, and evidence of diastolic dysfunction. His blood pressure has been well controlled on a low dose of one antihypertensive medication, and he has had regular medical checkups for his entire life.

What is the most likely etiology of this patient's LVH?

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