A better knowledge of the workings of microcirculation undoubtedly will lead to the development of novel therapies to treat the metabolic syndrome. Vascular smooth muscle cells are responsible for managing much of the peripheral systemic blood flow and contribute to what we measure as the clinic blood pressure. Vascular tone is controlled by factors secreted by endothelial cells, sympathetic nerves and circulating hormones. To understand how hypertension produces non-hypertrophic changes in small arteries, one must look at the physiological role of the resistance vasculature. Eutrophic inward remodelling is a process of structural adaptation observed in most forms of hypertension, including the onset of hypertension and milder hypertensive states. A few animal models of hypertension, such as a model developing hypertension independent of the renin—angiotensin system, demonstrate hypertrophy as the predominating structural change. Perivascular adipose tissue may be the link between obesity and hypertension.