It is well established that essential hypertension is associated with alterations in the structure of the resistance vasculature, such that the ratio of the media thickness to the lumen diameter (media-to-lumen ratio) is increased. Although these abnormalities are commonly thought to be due to vascular growth, they could be due to a rearrangement of a normal amount of material around a smaller lumen, a process known asremodeling.This paper reviews evidence for the relative contributions of growth and remodeling regarding subcutaneous resistance arteries taken from patients with essential hypertension. The available evidence suggests that the increased media-to-lumen ratio is due more to remodeling than to growth. This finding raises the possibility that vascular growth may not play a dominant role in the etiology of essential hypertension.