Intensive blood pressure control cuts 7-year dementia risk by 15%, study finds

This study was conducted through the China Rural Hypertension Control Program (CRHCP), where 326 rural villages in China were randomly selected to receive either a non-physician community healthcare provider-led intervention or usual care.

Almost 34,000 adults (ages 40 and older) with an average age of 63 took part in the study. Participants either had an untreated systolic blood pressure (SBP) of at least 140 mmHg or a diastolic blood pressure (DBP) of at least 90 mmHg (or at least 130/80 mmHg if currently on antihypertensive medication or at high risk for cardiovascular disease).

Participants in the blood pressure-lowering intervention group received blood pressure medications from non-physician community healthcare providers under doctor supervision to help them achieve an SBP of less than 130 mmHg and a DBP of less than 80 mmHg.

At the study’s conclusion, researchers found that participants in the intervention group achieved lower blood pressure reductions after seven years, when compared to the usual care group.

Additionally, intervention group participants also had a 15% lower risk of developing dementia and 13% reduced risk for cognitive impairment when compared to the usual care group.

“Hypertension is known to be a modifiable risk factor for dementia but there is still limited long-term evidence that blood-pressure lowering can prevent dementia at the population level,” Yingxian Sun, MD, PhD, director of the Department of Cardiovascular Medicine at The First Affiliated Hospital of China Medical University in China, and principal investigator of CRHCP, says in a press release.

“In this large community-based trial, a scalable intervention delivered by non-physician healthcare providers not only resulted in substantial reductions in blood pressure but also reduced the risk of dementia. These results support the long-term sustainability of integrating structured blood pressure management into routine primary care for dementia prevention at the population level.”
—Yingxian Sun, MD, PhD

Medical News Today spoke with Dung Trinh, MD, an internist for MemorialCare Medical Group and chief medical officer of the Healthy Brain Clinic in Irvine, CA, who commented this is an important and encouraging study because it suggests that a very practical, scalable intervention — better blood-pressure control — may significantly reduce dementia risk over time.

“What stands out to me is that this was not a highly specialized intervention; it was delivered largely through trained community healthcare providers with primary-care physician oversight,” Trinh, who was not involved in this study, said. “That makes the findings particularly relevant to real-world primary care and public health.”

Trinh explained that high blood pressure can damage the small blood vessels that supply the brain, contribute to strokes and silent vascular injury, and over time reduce the brain’s resilience to other forms of neurodegeneration.

“By controlling blood pressure, we may reduce cumulative vascular damage, preserve blood flow, and brain health, and potentially lessen the combined burden of vascular disease and underlying Alzheimer’s-related pathology.”
— Dung Trinh, MD

“It is important to note, however, that this study looked at all-cause dementia, so it does not establish that blood-pressure lowering specifically prevents Alzheimer’s disease or directly changes amyloid or tau biology“Trinh noted.

MNT also spoke with Yu-Ming Ni, MD, a board certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was also not involved in this study.

“This study reinforces what we’ve known all along, which is that blood pressure is a major contributor to neurovascular health in general and dementia,” Ni explained.

“While dementia has multiple causes beyond just vascular and circulatory flow, there’s this belief that better blood pressure control can help with your neurological health. And so I think this helps to reinforce what we already understand about dementia risks, especially in the realm of vascular dementia in particular,” he said.

“Brain cells need a healthy circulation to function. And especially when we’re talking about the brain with the essential functions that it has and sensitivity to blood pressure, I think it’s certainly not a surprise that it would be important to have a well regulated blood pressure to bring blood flow, bring nutrients to the brain.”
—Yu-Ming Ni, MD

For the next steps in this research, Trinh said he would like to see these findings replicated in more diverse populations and healthcare settings, with greater detail on which patients benefit most and how intensive blood-pressure targets should be individualized, particularly in older adults who may be more vulnerable to falls, kidney problems, or low blood pressure.

“It would also be valuable to understand the mechanisms behind the dementia reduction,” he continued. “For example, whether the benefit is primarily driven by fewer strokes and less vascular brain injury, or whether there are broader effects on Alzheimer’s-related neurodegeneration.”

“My hope is that this (study’s findings) will continue to spur on research into a more detailed determination of the mechanisms by which dementia occurs,” Ni added. “I do hope we continue to do research in this field to better understand how dementia forms and how we can prevent it from happening.”