Blood pressure remains a central determinant of long-term mortality in life and health insurance underwriting, but emerging evidence has substantially refined how that risk is interpreted and classified. Large insured lives studies and contemporary population cohorts now demonstrate that systolic blood pressure is the principal driver of all-cause mortality across most adult age groups, with risk increasing progressively above low-normal ranges and diastolic pressure acting primarily as a modifier at extremes. These findings extend beyond earlier threshold-based models and support interpretation of blood pressure as a continuous and cumulative exposure. Recent epidemiologic and cohort data further show that mortality risk associated with blood pressure is strongly influenced by age, sex, duration of elevation, longitudinal trajectories, and treatment status. Incorporation of covariates such as body mass index, smoking, renal function, diabetes, and medication use has clarified heterogeneity in risk and enabled more precise stratification than was previously possible. Ambulatory blood pressure monitoring, particularly nighttime systolic pressure, has emerged as a powerful tool for identifying sustained exposure and masked hypertension, refining mortality prediction beyond office measurements alone. This chapter also reviews contemporary evidence linking abnormally low blood pressure and orthostatic hypotension to increased mortality across age groups. Together, these data support the evolution of algorithmic and multivariable risk models that integrate blood pressure with key covariates, allowing underwriting decisions to more accurately reflect true long-term mortality risk.