Key PointsQuestionHow does the magnitude of projected cognitive benefit from intensive vs standard systolic blood pressure (SBP) treatment vary across patients?FindingsIn this secondary analysis of 7918 participants in the Systolic Blood Pressure Intervention Trial with a median follow-up of 4 years, participants with higher baseline risk of probable dementia or amnestic mild cognitive impairment (MCI) gained greater absolute cognitive benefit from intensive vs standard SBP treatment.MeaningThese findings suggest that intensive SBP treatment reduces the risk of combined MCI or dementia overall and to a greater degree among those with higher baseline risk of MCI or dementia in a monotonic fashion.