Aging represents an important risk factor in the development of cardiovascular disease (CVD). Nevertheless, the question arises: How immutable is age as a risk factor? Can we make a distinction between physiologic or successful arterial aging, which may be immutable, and accelerated, pathologic arterial aging-frequently referred to as early vascular aging (EVA)-which is not? Indeed, blood pressure (BP) components that change over time are useful metrics for assessing and comparing physiologic versus pathologic aging. Because EVA often starts in adolescence, while CVD events may not appear until middle-age or beyond, there is a potential opportunity to attenuate pathological aging with early and effective lifestyle and/or therapeutic intervention.EVA can occur prior to and in association with elevated in-office BP and commonly clusters with other CVD risk factors. Increased peripheral vascular resistance and arterial stiffness are two important hemodynamic abnormalities that accelerate pathologic aging. The proportion of increased resistance versus increased stiffness varies with age, sex, and a variety of covariates that include obesity, metabolic syndrome, diabetes, and prior CVD events. Pathologic aging occurs predominantly with increased vascular resistance in the early adult years (more often in men) and predominantly with increased stiffness in the later adult years (more often in women). Pathologic aging over many years predisposes to later CVD events, including coronary heart disease, heart failure, stroke, cogitative impairment, and chronic kidney disease. Early and aggressive treatment of persons at risk may provide greater protection against pathologic vascular aging of heart, kidneys, and brain, and hence delay or prevent later CVD events. The establishment of the optimal level of BP to initiate antihypertensive therapy and optimal target goal of therapy to minimize pathologic arterial aging, are questions that will require further investigations.