“…While hypoxia-induced remodeling is associated with medial hypertrophy, direct stimulation of SMC proliferation by hypoxia remains somewhat controversial (37). Although there are reports of hypoxia driven smooth muscle cell proliferation (38,39), several in vitro studies have shown that hypoxia does not directly increase SMC proliferation (40)(41)(42) or may actually decrease proliferation (43,44). However, fibroblasts that are less differentiated than the other two main vascular cell types, have a greater proliferative response to hypoxia (44)(45)(46).…”