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Do you ever worry about a blow out at 45psi?

I’m just so used to 32 to 35 psi that 45 seems insanely high and rather close to the max 50 psi. I checked the door sticker and it does say 45 psi... but on not perfect roads, does anyone worry about tire damage at that high of pressure?
Nope, never a problem. There are a number of things that we have to get use to. That pressure is necessary because of the weight of the vehicle. If you run the pressure lower you will pay in excessive tire wear and poor range.

It's not due to the weight of the vehicle. Plenty of similarly heavy BMWs and Mercedes use lower air pressure. If it was due to weight, the standard range and mid range models would have different recommended tire inflation values.

Tesla went with 45 PSI to reduce rolling resistance, at the expense of reduced grip and increased road noise.
it does say 45 psi... but on not perfect roads, does anyone worry about tire damage at that high of pressure?

Not in the slightest.

The primary cause of blowouts is underinflated tires... an underinflated tire flexes constantly, gets very hot, and when the structure then fails at high speed (or when hitting a pothole), it flies apart in a "blowout." It doesn't matter whether there's 20 pounds or 60 pounds of pressure inside the tire... when it falls apart, it will "blow out."

And if you happen to be carrying a heavy load, the way to reduce risk and maximize the ability of the tire to carry the load is to inflate it to the max pressure listed on the tire. If you don't inflate it to the max pressure, the heavy load can cause the tire to squish and flex, which creates heat, which leads to the blowout.
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I have run my trailer tires at the recommended pressure. Some were as high as 90 psi. I never had a flat nor a blow out. I replaced them every 5 years. Nothing to worry about as long as the tires are rated for it.
Man, I didn't know I was down to ~ 40 PSi. Brought it up to 45, and
it's like a different car. Feels brisk, like a brisket on ball bearings.
Actually seems quieter. Steers differently. The AS feels tighter.
I dunno about 49, that might be Prussian rectumlinear, but 41
was way too gooshey wooshey. So happy with such little things
now that I have a Tesla.
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The sticker on my door says 42 PSI, but they're usually around 40 (but due to the dip in temperatures its now down to 38).
That is why they are XL tires. The tires that you used to put 32 or 36 lbs in probably were not XL tires with a Max of 50 lbs.

Tires are rated Max at Cold PSI. They may go above when hot (within reason).

It’s interesting the same tire on AWD the door tag says 42 PSI, but RWD says 45 PSI.
What part of rated to 50psi cold is confusing? Once you see marked on the tire that it is manufacturer rated to a higher pressure what is the concern.

Are you as skeptical of Elon saying a Tesla motor is rated to 500k..........when we know a significant number of Model S have had motors replaced and the rest of it is just a car that wears out the same as any other?
I once found my 18" stock aero tire (forget the name of them) at 80 something PSI after getting it back from a body shop. Thought the screen was showing an incorrect number. Checked it with a gauge and sure enough.

The tire did not fail and is still going strong to this day. This was over a year ago.