Best Evidence Yet That Lowering Blood Pressure Can Prevent Dementia

Summary: Results imply a linear relationship between blood pressure reduction and lower dementia risk in adults aged 69 and older.

Source: George Institute for Global Health

A global study of over 28,000 people has provided the strongest evidence to date that lowering blood pressure in later life can cut the risk of dementia.

Dr Ruth Peters, Associate Professor at UNSW Sydney and Program Lead for Dementia in The George Institute’s Global Brain Health Initiative, said that in the absence of significant dementia treatment breakthroughs, reducing the risk of developing the disease would be a welcome step forward.

“Given population ageing and the substantial costs of caring for people with dementia, even a small reduction could have considerable global impact,” she said. 

“Our study suggests that using readily available treatments to lower blood pressure is currently one of our ‘best bets’ to tackle this insidious disease.”

Dementia is fast becoming a global epidemic, currently affecting an estimated 50 million people worldwide. This is projected to triple by 2050 – mainly driven by aging populations.

It is currently estimated to cost US$20-$40,000 per person with the condition each year.
Dr Peters explained that while many trials have looked at the health benefits of lowering blood pressure, not many included dementia outcomes and even fewer were placebo-controlled – considered to provide the best level of evidence.
“Most trials were stopped early because of the significant impact of blood pressure lowering on cardiovascular events, which tend to occur earlier than signs of dementia,” she said. 

To examine the relationship between blood pressure and dementia more closely, researchers analysed five double-blind placebo-controlled randomised trials that used different blood pressure lowering treatments and followed patients until the development of dementia.

A total of 28,008 individuals with an average age of 69 and a history of high blood pressure from 20 countries were included. Across these studies, the mid-range of follow up was just over four years.

“We found there was a significant effect of treatment in lowering the odds of dementia associated with a sustained reduction in blood pressure in this older population,” said Dr Peters.

“Our results imply a broadly linear relationship between blood pressure reduction and lower risk of dementia, regardless of which type of treatment was used.”

Researchers hope the results will help in designing public health measures to slow the advance of dementia as well as informing treatment, where there may be hesitations around how far to lower blood pressure in older age.

This shows a person having their blood pressure taken
Dementia is fast becoming a global epidemic, currently affecting an estimated 50 million people worldwide. Image is in the public domain

“Our study provides the highest grade of available evidence to show that blood pressure lowering treatment over several years reduces the risk of dementia, and we did not see any evidence of harm,” said Dr Peters.

“But what we still don’t know is whether additional blood pressure lowering in people who already have it well-controlled or starting treatment earlier in life would reduce the long-term risk of dementia,” she added.

Professor Craig Anderson, Director of the Global Brain Health program at The George Institute said, “this work is an important foundation for clinical trials to provide reliable estimates of the benefits and risks of preventative treatments, and how best to apply them across different populations.” 

Funding: The authors report no targeted funding. R.P. is funded by the Australian National Health and Medical Research Centre Australian Dementia Centre for Research Collaboration, and Neuroscience Research Australia; Y.X. is funded by NHMRC Project Grant (APP1160373); M.W. and C.S.A. are supported by Investigator Grants (APP1174120 and GNT1175861 respectively) from the National Health and Medical Research Council (NHMRC) of Australia, and together with J.C. receive funding from an NHMRC Program Grant (APP1149987); M.W. is a consultant to Amgen, Kyowa Kirin, and Freeline; J.C. has received research grants from Servier, and from the NHMRC for both PROGRESS and ADVANCE, and honoraria from Servier for speaking about them at Scientific meetings; C.S.A. has received research grants from Penumbra, Takeda, Credit, and Genesis paid to his institution.

About this dementia and blood pressure research news

Author: Tina Wall
Source: George Institute for Global Health
Contact: Tina Wall – George Institute for Global Health
Image: The image is in the public domain

Original Research: Open access.
Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis” by Ruth Peters et al. European Heart Journal


Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis


Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia.

Methods and results

Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk.


The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia.

Classification of evidence

Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.

Join our Newsletter
I agree to have my personal information transferred to AWeber for Neuroscience Newsletter ( more information )
Sign up to receive our recent neuroscience headlines and summaries sent to your email once a day, totally free.
We hate spam and only use your email to contact you about newsletters. You can cancel your subscription any time.