Hypertension is associated with altered structure of the resistance vessels, a process known as remodeling. This review summarizes current concepts concerning the structure of a subgroup of the resistance vessels, the small arteries, and the modes of remodeling, some of the determinants of remodeling, and some signaling pathways for remodeling. It is shown that the available evidence points to important roles for blood flow and growth factors, in addition to blood pressure, as causes of resistance artery remodeling. Finally, the relationship between vascular structure and blood pressure is discussed, in particular with regard to the effects of antihypertensive therapy. Here again, it appears that blood flow plays an important role in allowing the correction of the abnormal resistance vessel structure seen in hypertension.