Hypertension has emerged as an important risk factor in cardiovascular diseases. However, the success of antihypertensive treatment in reducing cardiac mortality is limited. It is becoming clear that structural changes in the resistance vessels and, indeed, other vascular changes such as hypertrophy in the aorta and left ventricle increase the risk of premature cardiac events. Future therapy for hypertension must be directed at not only lowering blood pressure but also reversing structural alterations in the vasculature.