Raised blood pressure is damaging in a range of ways, the most obvious of which is pressure damage to sensitive tissues. For example, high blood pressure increases the pace of rupture of capillaries. In the brain these microbleeds leave areas of permanent damage known as hyperintensities for their appearance in imaging of brain tissue. This form of harm adds up over time, and is well demonstrated to correlate with loss of cognitive function and the development of dementia.
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 mmHg and a diastolic BP goal of <80 mmHg, with supervision from primary care physicians.
Over 48 months, the net reduction in systolic BP was 22.0 mmHg and that in diastolic BP was 9.3 mmHg 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). Additionally, serious adverse events occurred less frequently in the intervention group (risk ratio: 0.94). This cluster-randomized trial indicates that intensive BP reduction is effective in lowering the risk of all-cause dementia in patients with hypertension.
Link: https://doi.org/10.1038/s41591-025-03616-8
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