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We tested whether intensive systolic blood pressure (SBP) treatment reduced the risk of new SBI or stroke and determined the association between SBI and cognitive impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this secondary analysis of SPRINT (Systolic Pressure Intervention Trial), participants \u226550\u2009years old, with SBP 130\u2013180mmHg and elevated cardiovascular risk but without known clinical stroke, dementia, or diabetes, were randomized to intensive (&lt;120mmHg) or standard (&lt;140mmHg) SBP treatment. Brain magnetic resonance images collected at baseline and follow\u2010up were read for SBI. The occurrence of mild cognitive impairment (MCI) or probable dementia (PD) was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For 667 participants at baseline, SBI were identified in 75 (11%). At median 3.9\u2009years follow\u2010up, 12 of 457 had new SBI on magnetic resonance imaging (5 intensive, 7 standard), whereas 8 had clinical stroke (4 per group). Baseline SBI (subhazard ratio [sHR]\u2009=\u20093.90; 95% CI 1.49 to 10.24; <jats:italic>p<\/jats:italic>\u2009=\u20090.006), but not treatment group, was associated with new SBI or stroke. For participants with baseline SBI, intensive treatment reduced their risk for recurrent SBI or stroke (sHR\u2009=\u20090.050; 95% CI 0.0031 to 0.79; <jats:italic>p<\/jats:italic>\u2009=\u20090.033). Baseline SBI also increased risk for MCI or PD during follow\u2010up (sHR\u2009=\u20092.38; 95% CI 1.23 to 4.61; <jats:italic>p<\/jats:italic>\u2009=\u20090.010).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>New cerebral ischemic events were infrequent, but intensive treatment mitigated the increased risk for participants with baseline SBI, indicating primary prevention SBP goals are still appropriate when SBI are present. ANN NEUROL 2024;95:866\u2013875<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.26892","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T09:38:23Z","timestamp":1708076303000},"page":"866-875","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Intensive Blood Pressure Treatment and Subclinical Brain Infarcts: A Secondary Analysis of SPRINT (Systolic <scp>Pressure Intervention<\/scp> Trial)"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-7669","authenticated-orcid":false,"given":"Kyle C.","family":"Kern","sequence":"first","affiliation":[{"name":"Stroke Branch, National Institute of Neurological Disorders and Stroke National Institutes of Health  Bethesda Maryland USA"},{"name":"Department of Neurology University of California, Los Angeles David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya M.","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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