N early 50% of our population by 65 years of age has a systolic pressure within a "risky" range, that is, has predominantly systolic hypertension (PSH), 1 attributable, in part, to a reduction in large artery compliance because of an increased stiffness of the arterial wall. For a given pattern of left ventricular ejection, arterial stiffening reduces diastolic pressure and increases pulse pressure. Although increased arterial stiffness elevates pulse pressure, it is not itself sufficient to raise systolic pressure to hypertensive levels, unless accompanied by an increase in stroke volume or peripheral vascular resistance (PVR). 2 Whereas the former is not increased in older persons with PSH, the latter is higher (by Ϸ15% on average) than in age-matched normotensive persons. 3 This mild-moderate elevation of PVR is usually unrecognized because it is not routinely assessed. The increased large artery stiffness that accompanies PSH precedes the elevation of arterial pressure to clinically defined hypertensive values, 4 giving rise to the notion that this form of hypertension, at least in part, is a disease of the arterial wall. Moreover, elevated pulse wave velocity, an index of arterial stiffness, and reduced total systemic compliance, assessed by stroke volume/pulse pressure, are themselves independent predictors of future cardiovascular events, even after accounting for the effect of the concomitant increase in blood pressure. 5,6 There is substantial evidence to indicate that the NaCl dependence of arterial pressure increases with advancing age and that this age effect is exaggerated in older hypertensive patients. 7 In this issue of Hypertension, Gates et al 8 add to this perspective by demonstrating that a reduction in dietary sodium to approximately 60 mmol/d, considered to be a low sodium intake by the Dietary Approaches to Stop Hypertension (DASH) study, 9 effectively lowers arterial pressure in older persons with PSH. Gates et al 8 also confirm prior observations that reducing dietary NaCl increases arterial compliance and reduces arterial stiffness. 10 Of particular note is that both the compliance and stiffness effects were evident 1 to 2 weeks following a reduction in NaCl. 8 Although PVR was not measured in their study, the Gates et al results demonstrate that reduction in dietary NaCl reduces diastolic as well as systolic pressure in PSH; pulse pressure is also reduced. 8 In addition to its effect on arterial pressure, NaCl affects arterial stiffness by altering vascular structure and smooth muscle cell and endothelial cell function. Both clinical and experimental evidence indicate that NaCl induces hypertrophy of the arterial wall in the absence of changes in arterial pressure 11 and induces hypertrophy of cultured vascular cells. 12 Excessive NaCl intake reduces the bioavailability of nitric oxide by interfering with the induction of nitric oxide synthase; by increasing asymmetric dimethylarginine, an endogenous nitric oxide synthase inhibitor, 13 reducing the production of nitric oxide; and by el...