Although it is clear that inadequate perfusion underlies most of the organ dysfunction accounting for hypertension-related adverse outcomes, our understanding of the pathophysiologic mechanisms is still evolving. The most important approaches to improving vascular health include reducing injury to the vessel wall and enhancing mechanisms to repair/restore vessel wall function. The main factors responsible for repairing cardiovascular function include vascular progenitor cells and angiogenesis. The purpose of this article is to bring together recent findings indicating that limitations in vascular progenitor cell function seen in hypertension underlie the increased risks for coronary artery disease and other vascular-related adverse outcomes. Improved understanding of systems for vascular repair holds promise for new therapeutic applications in the future, although this subject will not be dealt with in this article. We will focus on a pivotal defense mechanism - bone marrow-derived progenitor cells and their roles in hypertension.