Hypertension and dementia: Can lowering blood pressure reduce the risk of dementia?

Researchers examine the effectiveness of intensive BP intervention in lowering the risk of dementia in real-world primary care settings within resource-constrained communities.

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.

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.