Recent evidence suggests a role for reactive oxygen species in the control of vascular smooth muscle proliferation both in vitro and in vivo. Oxidative stress increases cell proliferation, mediates hormone-induced hypertrophy, and-under some circumstances-induces apoptosis. Smooth muscle cells contain a reduced nicotinamide adenine dinucleotide/reduced nicotinamide adenine dinucleotide phosphate oxidase that is responsible for the majority of the superoxide produced by the vessel wall. This enzyme has been characterized biochemically, but only limited information is available regarding its molecular structure. High levels of oxidative stress are apparently involved in the pathogenesis of vascular diseases such as hypertension and atherosclerosis, along with abnormal vascular growth after balloon injury. Thus the pathways responsible for oxidative stress, as well as the antioxidant defenses in the vessel wall, may provide novel therapeutic targets.