Background Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure. Aims To examine lifetime blood pressure as a predictor of brain structure in old age. Method A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities. Results Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P