According to an editorial, the SPRINT trial has already changed clinical care, so it will be of great interest to watch how the results of SPRINT MIND influence approaches to maintaining brain health and preventing cognitive impairment. It notes critical questions will be when to treat elevated systolic BP and whether the same goal of care should be applied to adults of all ages. It adds that one group that deserves special consideration is the oldest old (≥85 years); several observational studies have reported an inverse association of hypertension on the risk of dementia with a protective effect among the oldest old. It suggests this may be partly explained by survival bias, but it is possible that higher perfusion pressure may be beneficial to brain health at that advanced age, which is important given that the incidence of mild cognitive impairment and dementia continues to increase in very late life and adverse events from intensive BP control also increase. It also notes that as participants were excluded from SPRINT if they had diabetes, stroke, or symptomatic heart failure, the intensive systolic BP control approach used in this trial cannot be generalised to older adults with those conditions.