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Hypertension is a risk factor for dementia. Researchers conducting this substudy from the Systolic Blood Pressure Intervention Trial (SPRINT MIND) compared the efficacy of intensive versus standard blood pressure lowering on MRI brain biomarkers for Alzheimer disease (AD) in dementia-free participants >50 years with systolic blood pressure (SBP) between 130 and 180 mm Hg. Goal SBP was <120 mm Hg in the intensive treatment (n=356) and <140 mm Hg with standard treatment (n=317). At baseline (mean age, 67 years; 32% Black; mean BP, 138.78) and 4-year follow-up, AD-related findings were measured, including cognitive performance and several brain MRI–based findings: longitudinal hippocampal volumes, cortical thickness, spatial pattern for the re…