Trial Report Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: [...], 2025, He et al

Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial

Jiang He, Chuansheng Zhao, Shanshan Zhong, Nanxiang Ouyang, Guozhe Sun, Lixia Qiao, Ruihai Yang, Chunxia Zhao, Huayan Liu, Weiyu Teng, Xu Liu, Chang Wang, Songyue Liu, Chung-Shiuan Chen, Jeff D. Williamson & Yingxian Sun

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Abstract
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.

Link (Nature Medicine) [Paywall]

 

Science: 'News at a Glance'

"Blood pressure and dementia
A trial of nearly 34,000 people in rural China offers some of the best evidence yet that reducing high blood pressure, alongside lifestyle changes, can lower risk of cognitive impairment and dementia.

The study, described this week in Nature Medicine, involved 326 Chinese villages; in half, participants ages 40 and older with uncontrolled high blood pressure received antihypertensive medication, home blood pressure monitoring, and healthy lifestyle coaching from community health workers.

After 4 years, these participants were 15% less likely to have developed dementia and 16% less likely to have cognitive impairment without dementia, compared with people in the control villages, where health workers didn’t provide medication or coaching.

In 2019 a U.S. trial in about 9000 people showed blood pressure treatment reduced mild cognitive impairment, but did not show a statistically significant reduction in dementia."

 

What would have happened with only lifestyle coaching? In other words - how much does the medication contribute to the effect?