Intracellular pH (pH<sub>i</sub>) is a physiological parameter that is intimately linked to contractility, growth and proliferation of vascular smooth muscle (VSM). Regarding contractility, no general unifying concept of pH<sub>i</sub> regulation but a rather complex relation between pH<sub>i</sub> signals and vascular tone has been revealed so far. The modulation of vasotone by pH<sub>i</sub> depends on the type of blood vessel as well as on the pattern of regulatory input signals. In addition, changes in pH<sub>i</sub> have been recognized as an important cellular signal to determine the fate of cells in terms of proliferation or apoptosis. Cellular sensors for pH<sub>i</sub> include a variety of ion transport systems which control intracellular Ca<sup>2+</sup> gradients and are likely to serve as a link between pH<sub>i</sub> and cell functions. Here we provide an overview on the potential targets and mechanisms that transduce pH<sub>i</sub> signals in VSM. The role of pH<sub>i</sub>-sensing signaling complexes and localized pH<sub>i</sub> signaling as the basis of diversity of pH<sub>i</sub> regulation of VSM function is discussed.