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Oxidative stress and smooth muscle cells (SMCs) are major contributors to pulmonary arterial hypertension, atherosclerosis, and systemic hypertension. In this review, the authors discuss how redox balance in SMC by vascular NADPH oxidases, mitochondria bioenergetics, as well as the soluble guanylate cyclase–cyclic guanosine monophosphate–protein kinase G pathway can functionally change SMC from contractile to phenotypically diverse cells and vice versa.