The vessel wall was once considered to be a passive conduit responding to the circulating endocrine system. However, the emergence of molecular and vascular biology in hypertension research has redefined our understanding of the role of the vasculature as a vital organ in the pathogenesis of hypertension. It is now recognized that the vasculature can regulate its own tone by a variety of previously unknown autocrine and/or paracrine vasoactive systems. Recent evidence indicates that the process of vascular remodeling in hypertension appears to be mediated by locally generated factors within the vessel wall. This review examines the implications of this new paradigm in hypertension, focusing on O ver the past half century, the direction of hypertension research has been shaped by a scientific paradigm that has focused on the regulation of systemic neuroendocrine vasoactive systems that control vascular tone and renal fluid-electrolyte homeostasis. This paradigm postulates that hypertension is caused by a disturbance in the physiological homeostatic mechanisms regulating the levels of and/or responses to circulating hormones and sympathetic nervous system activity. In this schema the vasculature is conceptualized as a simple effector system that passively responds to the actions of systemic neuroendocrine factors. However, advances in molecular vascular biology have begun to promote a paradigm shift that has dramatically altered our conception of the role of the vasculature in hypertension. Based on recent studies it has become increasingly clear that the vasculature is itself a complex, integrated organ capable of autonomous generation of locally active factors that mediate changes in tone and structure. This review will examine the implications of this new molecular vascular biology paradigm in hypertension research, focusing on five areas in which vascular biology has had or will have major effects on hypertension research: (1) the discovery of novel endogenous biologically active molecules synthesized by the vessel wall, (2) the elucidation of molecular mechanisms and consequences of vascular remodeling in hypertension, (3) an understanding of the developmental biology of the blood vessel and the relation to pathobiology, (4) the in vivo testing of in vitro hypotheses using in vivo gene transfer, and (5) the development of novel treatment strategies based on vascular molecular biology, such as gene therapy.