Angiogenesis is impaired in aged tissues. It is probable that this deficit contributes to the increased severity of vascular diseases observed in older persons. The changes in angiogenesis that occur with aging have been noted at the molecular, cellular, and physiologic levels of regulation. Components of the neovascular process that are influenced by age include endothelial cells, the hemostatic cascade, neuro-chemical mediators, and growth factors and their cognate receptors. The structural and regulatory components of the matrix scaffold that surround newly formed vessels is also altered in aged tissues. These myriad changes result in delayed and impaired neovascularization. The clinical consequences of the decreased potential of aged tissues to form new vessels is detrimental during the revascularization of the ischemic heart and during the repair of injured tissues, but may be of benefit in slowing the growth of tumors. In this context, clinical strategies to improve the function of the aging vasculature in general, and the angiogenic response in particular, must be targeted to specific disease states in order to maximize the potential benefit to older individuals.