LAUSR

That blood pressure (BP) increases with age has been known for almost a century. To what extent this increase in BP is physiological continues to be debated. The observation that in some isolated populations there is little if any BP slope with age is often taken as an argument that any increase in BP should be considered pathological. Conversely, once upon a time, textbook wisdom (those who taught) such as “the elevation of blood pressure may be a natural response to guarantee a more normal circulation to the heart, brain and kidneys”1 or “the hypertension might be a compensatory mechanism that should not be tampered with”2 has continued to spook physicians until this very day and seemed to attest to the “essentiality” of essential hypertension. This concept also instigated fear that, in susceptible patients, BP could be lowered too much. The thorough meta-analysis by Lewington et al3 alleviated these concerns by concluding that “usual BP is strongly and directly related to vascular (and overall) mortality without any evidence of a threshold down to at least 115/75 mm Hg.” However, closer scrutiny documents BP to gradually become a less powerful risk factor with age. At ages 40 to 49 years, a 20–mm Hg lower systolic …