Abstract Body: Small artery remodeling and endothelial dysfunction are hallmarks of hypertension. Growing evidence supports a likely causal association between cardiovascular diseases and the presence of endothelial-to-mesenchymal transition (EndMT). EC reprogramming represents an innovative strategy in regenerative medicine to prevent deleterious effects induced by cardiovascular diseases. Using reprogramming of ECs, via overexpression of Oct-3/4, Sox-2, and Klf-4 (OSK) transcription factors, we aimed to bring ECs back to a youthful phenotype in hypertensive mice. Mouse ECs were infected with lentiviral vectors (LV) containing the specific EC marker cadherin 5 (Cdh5) and the fluorescent reporter enhanced green fluorescence protein (EGFP) with empty vector (LVCO) or with OSK (LV-OSK). Confocal microscopy and western blotting analysis were used to confirm the OSK overexpression. Human aortic ECs (HAoECs) from male and female normotensive and hypertensive patients were analyzed after OSK or control treatments for their endothelial nitric oxide synthase (eNOS) levels, nitric oxide (NO), and genetic profile. Male and female normotensive (BPN/3J) and hypertensive (BPH/2J) mice were treated with an intravenous (i.v.) injection of LVCO or LV-OSK and evaluated 10 days post-infection. The blood pressure, vascular reactivity of small arteries, in vivo EGFP signal and EndMT inhibition were analyzed. Data were analyzed using One-way or Two-way ANOVA, with Tukey post-hoc (p<0.05). OSK overexpression induced partial EC reprogramming in vitro. OSK treatment of male but not female hypertensive BPH/2J mice normalized blood pressure (BPH/2J LVCO: 105±2mmHg, n=6 versus BPH/2J LV-OSK: 90±2mmHg, n=5) and resistance arteries hypercontractility (BPH/2J LV-CO: 10.50±0.82mN versus BPH/2J LV-OSK: 7.12±0.6mN, n=5), via the attenuation of EndMT (BPH/2J LVCO: 0.041±0.01AU, n=3 versus BPH/2J LV-OSK: 0.007±0.004 AU, n=3) and elastin breaks. EGFP signal was detected in vivo in the prefrontal cortex of BPN/3J and BPH/2J-treated mice, but OSK induced angiogenesis in male BPN/3J mice. OSK-treated human ECs from hypertensive patients showed high eNOS activation and NO production, with low ROS. Single-cell RNA analysis showed that OSK alleviated EC senescence and EndMT, restoring their phenotypes in human ECs from hypertensive patients. Overall, these data indicate that OSK treatment and EC reprogramming can decrease blood pressure and reverse hypertension-induced vascular damage.