Alteration of resistance artery geometric design is a hallmark of established hypertension. In particular, there is an increased media thickness: lumen diameter ratio. In this review, consideration is given to the methods available for assessment of vascular structure, the terminology used to describe vascular structural changes in hypertension and the possible functional consequences of altered arterial design in the maintenance of the hypertensive state. In light of these considerations, a number of proposals are made concerning quantification strategies and descriptor terminologies. In particular, a simple descriptor terminology is proposed that describes such structural differences but makes no assumptions concerning the underlying processes that account for altered arterial structure in hypertension.