DBP tends to decline with age, from approximately the age of 40 to 50 years, due to progressive stiffening and loss of compliance of large conduit arteries, especially the aorta. This aortic stiffening tends to be accelerated in people with diabetes (6). The same mechanism accounts for the progressive rise in SBP with age and the consequent age-related increase in pulse pressure (7). Thus, the cohort of patients with low in-trial DBP are most likely to be older and have diabetes and more likely to have coronary heart disease and a higher SBP and pulse pressure. Therefore, they are the highest-risk cohort irrespective of subsequent treatment. Indeed, a review of the patient characteristics in a recent analysis of the J-curve phenomenon from a major clinical outcomes study of hypertensive patients clearly shows that those patients with a low in-trial DBP had baseline characteristics identical to those described in the preceding text—therefore, they were, not surprisingly, at higher risk of developing incident coronary events during the trial (8). The cohort of patients with low DBP at baseline would most likely have experienced the highest rate of cardiac events irrespective of whether their DBP was lowered further. This in turn highlights the key question in this debate: if a patient already has a low DBP, will they get benefit or harm from further DBP lowering? Whilst reflecting on this question, it is worth remembering that patients with a low DBP will also most likely be those with a high SBP and pulse pressure. Put simply, would you lower the BP of a patient with isolated systolic hypertension (ISH), (e.g., a BP of 180/70 mm Hg)? Current guidelines recommend that you should. Should this recommendation hold true if the patient also has evidence of coronary disease due to concerns about the impact of further DBP lowering? With regard to the latter, in patients with ISH, the fall in SBP will greatly exceed the fall in DBP. Indeed, with aging, the predominant effect of treatment is to lower SBP, because the ratio of DBP/SBP lowering with antihypertensive therapy progressively declines with age and low baseline DBP (9). This underscores the likelihood that the low in-trial DBP analyzed in the aforementioned analyses (5,8) almost certainly reflects a low baseline DBP rather than a dramatic treatment effect.