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div>Methods:? Within the AGES-Reykjavik study (2002-06), a population-based study, analyses were performed in 4306 non-demented older individuals (mean age 76��5?years) with data on vascular risk and brain volumes on MRI. Total brain (TB) volume was calculated by summing the gray matter (GM), white matter (WM), and white matter lesion (WML) volumes. Mid-life assessment of vascular factors was conducted between 1967�C96. Hypertension was defined as BP ��140/90?mm?Hg and/or use of antihypertensives. Results:? Regression analyses adjusted for age, sex, intracranial volume, vascular risk, WML, and brain infarcts showed that the association of late-life diastolic BP (DBP), but not systolic BP (SBP), with TB and GM was modified by midlife hypertension status (P-interaction<0.01). In subjects Oxygenase with midlife hypertension (n=1464), but not in those without midlife hypertension, lower late-life DBP was associated with smaller TB and GM volumes (Figure 1). No interaction between midlife hypertension and late-life BP on WM was observed, but higher BP was related with smaller WM volume. Conclusion:? Midlife hypertension in combination with lower late-life BP is associated with smaller brain volumes. These findings provide evidence of a cumulative effect of early hyper- and late hypo-perfusion that leads to certain subgroups in old age with increased susceptibility to brain atrophy. Keywords:? Hypertension; Blood Pressure; Brain Atrophy Kei Asayama,1,2 Takayoshi DNA Damage inhibitor Ohkubo,1,3 Hirohito Metoki,1 Taku Obara,1 Ryusuke Inoue,1 Masahiro Kikuya,1 Lutgarde Thijs,2 Jan A. Staessen,2,4 Yutaka Imai,1 HOMED-BP Investigators1,2,3 1 Tohoku University, Sendai, Japan; 2University of Leuven, Leuven, Belgium; 3Shiga University of Medical Science, Otsu, Japan and 4Maastricht University, Maastricht, The Netherlands. Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial assessed cardiovascular outcomes in hypertensive patients treated according to HBP. Four hundred and fifty-seven general practices throughout Japan participated in the multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure trial (HOMED-BP; 2001-2010) which involved 3518 patients (50% women; mean age 59.6?years) with an untreated systolic/diastolic HBP of 135�C179/85�C119?mm?Hg. In a 2?��?3?design, BKM120 supplier patients were randomized to usual (125�C134/80�C84?mm?Hg [UC]) vs. tight [<125/<80?mm?Hg (TC)] control of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs). During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. The primary endpoint was cardiovascular death plus stroke and myocardial infarction. At last follow-up (median 5.3?years), TC compared with UC patients used more antihypertensive drugs (1.82 vs. 1.74 defined daily doses, P=0.045), had more HBP reduction (21.