The intertwined epidemics of obesity and related disorders such as hypertension, insulin resistance, type 2 diabetes, and subsequent cardiovascular disease pose a major public health challenge. To meet this challenge, we must understand the interplay between adipose tissue and the vasculature. Microvascular dysfunction is important not only in the development of obesityrelated target-organ damage, but also in the development of cardiovascular risk factors such as hypertension and insulin resistance. The present chapter examines the role of microvascular dysfunction as an explanation for the associations among obesity, hypertension and impaired insulin-mediated glucose disposal. We also discuss communicative pathways from adipose tissue to the microcirculation.