Blood Pressure Reduction to Limit the Evolution of Vascular Brain Lesions in Elderly Individuals

This study looks at whether lowering blood pressure in older adults can slow the growth of white matter lesions in the brain — areas of damage visible on brain MRI that are associated with cognitive decline and dementia. The study targets people with hypertension and visible brain changes who also have memory concerns. You may be eligible if: - You are between 60 and 88 years old - You have cognitive concerns or mild cognitive impairment (MMSE score ≥ 20) - You have moderate-to-severe white matter lesions seen on brain MRI - You have high blood pressure (≥ 140/90 mmHg), treated or untreated - You have a reasonable level of education and social support You may NOT be eligible if: - You have severe low blood pressure when standing (orthostatic hypotension) - You are unable to have an MRI (e.g., pacemaker, metal implants, claustrophobia) - You have a serious illness with life expectancy under 3 months - You have a dementia type other than Alzheimer's, vascular, or mixed dementia - You are already on 4 or more blood pressure medications at maximum dose - You have severe kidney disease Talk to your doctor to see if this trial is right for you.