Summary: A massive study in rural China found that intensively lowering blood pressure significantly reduces the risk of dementia and cognitive decline in people with hypertension. Over 48 months, patients who received targeted care saw a 15% reduction in dementia and a 16% drop in cognitive impairment risk.
The intervention involved community healthcare workers helping patients reach blood pressure goals under 130/80 mm Hg. These findings support wider adoption of intensive blood pressure control to help combat the global dementia crisis.
Key Facts:
- Significant Impact: Intensive blood pressure reduction led to a 15% lower risk of dementia.
- Widespread Study: Over 33,000 people across 326 villages were included in the trial.
- Community-Based Strategy: Non-physician healthcare workers helped patients meet target BP goals.
Source: Liaoning Clinical Research Center for Hypertensive Diseases
Dementia is the fifth leading cause of death across the globe. In the absence of curative treatments, the primary prevention of dementia through the reduction of risk factors has become a public health priority.
However, definitive evidence supporting BP reduction for the primary prevention of dementia in hypertensive patients remains insufficient.
Researchers from multiple universities have come together to form the China Rural Hypertension Control Project Phase-3 (CRHCP-3),which is one of the largest randomized effectiveness trials.
Reducing high blood pressure substantially lowers the risk of dementia and cognitive impairment without dementia, according to the 48-month results .
These findings highlight the potential importance of widespread adoption of more intensive blood pressure control among patients with hypertension to reduce the global disease burden of dementia.
This study comprised 33,995 individuals across 326 villages in rural China, with 17,407individuals in the “intervention” group and 16,588 in the usual care group being studied and followed up for after 48 months. Those in the intervention group were adopted
the non-physician community healthcare providers (NPCHP) led multifaceted implementation strategy to reduce their blood pressure with the goal of reaching a systolic blood pressure (SBP, the first number in a blood pressure reading) of below 130 mm Hg and a diastolic blood pressure (DBP, the second number in a blood pressure reading) to under 80 mm Hg.
Researchers published their results in Nature Medicine in April 2025.
“Dementia has become a global public health crisis due to its high prevalence, increased mortality, and the significant financial and emotional burdens it places on patients, caregivers, and society as a whole.
“Only a few randomized controlled trials have tested the effect of medications that reduce blood pressure on the risk of dementia, and none have looked at it as a primary trial endpoint, except for the SPRINT-MIND trial.
“Intensive blood pressure reduction was associated with a non-significant 17% reduction in dementia events among SPRINT-MIND participants.” said Yingxian Sun, professor at the First Hospital of China Medical University and author of the study.
The results of the 48-month-long study showed a reduction of 22.0 mm Hg in the SBP of those who were in the intervention group and 9.3 mm Hg in the DBP compared to the group who received usual care.
This translates to around a 15% decrease in risk of all-cause dementia and a 16% lower risk for cognitive impairment no dementia (CIND).
“These findings provide additional motivation for patients with hypertension to reduce their blood pressure—not only to prevent cardiovascular disease, but also to lower their risk of dementia,” said Sun.
In the future, we will harness big data and artificial intelligence to enable early prediction of dementia and optimize individualized prevention and therapeutic strategies.
Jiang He of the Department of Epidemiology, Department of Internal Medicine, Department of Neurology and the Peter O’Donnell Jr. Brain Institute, all at the UT Southwestern Medical Center, Chuansheng Zhao, Shanshan Zhong, Huayan Liu, Weiyu Teng and Xu Liu of the Department of Neurology at the First Hospital of China Medical University, Nanxiang Ouyang, Guozhe Sun, Lixia Qiao, Chang Wang, Songyue Liu and Yingxian Sun of the Department of Cardiology at the First Hospital of China Medical University, Ruihai Yang of the Hanzhong People’s Hospital, Chunxia Zhao of the Divison of Cardiology at the Tongji Medical College of Huazhong Univeristy of Science and Technology, Chung-Shiuan Chen of the Tulan University Translational Science Institute and Jeff D. Williamson of the Sticht Center for Healthy Aging and Alzheimers Prevention at Wake Forest University contributed to this research.
Funding: The National Key Research and Development Program of the Ministry of Science and Technology of China, the Chinese Society of Cardiology Foundation and the Science and Technology Program of Liaoning Province made this research possible.
About this hypertension and dementia research news
Author: Zongmei Song
Source: Liaoning Clinical Research Center for Hypertensive Diseases
Contact: Zongmei Song – Liaoning Clinical Research Center for Hypertensive Diseases
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial” by Yingxian Sun et al. Nature Medicine
Abstract
Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial
Dementia is a leading cause of death and disability worldwide.
Here we tested the effectiveness of blood pressure (BP) reduction on the risk of all-cause dementia among 33,995 individuals aged ≥40 years with uncontrolled hypertension in rural China.
We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care.
In the intervention group, trained non-physician community healthcare providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP goal of <130 mm Hg and a diastolic BP goal of <80 mm Hg, with supervision from primary care physicians.
Over 48 months, the net reduction in systolic BP was 22.0 mm Hg (95% confidence interval (CI) 20.6 to 23.4; P < 0.0001) and that in diastolic BP was 9.3 mm Hg (95% CI 8.7 to 10.0; P < 0.0001) in the intervention group compared to usual care.
The primary outcome of all-cause dementia was significantly lower in the intervention group than in the usual care group (risk ratio: 0.85; 95% CI 0.76 to 0.95; P = 0.0035).
Additionally, serious adverse events occurred less frequently in the intervention group (risk ratio: 0.94; 95% CI 0.91 to 0.98; P = 0.0006).
This cluster-randomized trial indicates that intensive BP reduction is effective in lowering the risk of all-cause dementia in patients with hypertension.
ClinicalTrials.gov: NCT03527719.
