It has long been known that vascular reactivity is altered in preeclamptic patients compared with normal pregnant women. This change even occurs weeks earlier than any clinical manifestation of the disease. Many investigators believe that the conditions for the development of preeclampsia are set as early as the first trimester. These changes in vascular reactivity appear to be independent of the blood pressure because they also occur in chronic hypertensive women destined to have preeclampsia. This review focuses on these changes in vascular reactivity reported in preeclampsia. Increased reactivity of the blood vessels in preeclampsia has been described in most, but not all, studies. The cause for the differences in reactivity between vessels from preeclamptic and normal pregnant women is not known. However, it cannot be attributed solely and with certainty to abnormalities in endothelium-dependent relaxation or the nitric oxide system because the study results published to date remain contradictory. In addition to functional differences, vessels from normal pregnant and preeclamptic women show distinct mechanical properties.