Article Impact Level: HIGH Data Quality: STRONG Summary of Nature Medicine, 1–8. https://doi.org/10.1038/s41591-025-03616-8 Dr. Jiang He et al.
Points
- A phase 3 clinical trial in rural China assessed the effect of intensive blood pressure control on dementia risk among 33,995 individuals aged 40 and older with uncontrolled hypertension.
- The intervention group, which targeted a systolic blood pressure of <130 mm Hg and diastolic blood pressure of <80 mm Hg, achieved significant reductions in both systolic and diastolic blood pressure over 48 months.
- The study found that the intervention group had a significantly lower incidence of all-cause dementia than the usual care group, with a risk ratio of 0.85 and a P-value of 0.0035.
- The intervention group also experienced fewer serious adverse events, with a risk ratio of 0.94, suggesting that intensive blood pressure control not only reduces dementia risk but also has fewer harmful effects.
- The findings emphasize the importance of early, proactive blood pressure control in reducing dementia risk, particularly in low- and middle-income countries, and advocate for BP-lowering strategies as part of dementia prevention.
Summary
A recent phase 3 clinical trial aimed to assess the effect of intensive blood pressure (BP) control on the risk of dementia among 33,995 individuals aged 40 years or older with uncontrolled hypertension in rural China. The study utilized a cluster-randomized design, where 163 villages were assigned an intervention led by non-physician community healthcare providers, and 163 villages received usual care. The intervention group followed a stepped-care protocol targeting a systolic BP (SBP) of <130 mm Hg and diastolic BP (DBP) of <80 mm Hg. Over a median follow-up of 48 months, the intervention group achieved significant reductions in both SBP (22.0 mm Hg, 95% CI: 20.6 to 23.4; P < 0.0001) and DBP (9.3 mm Hg, 95% CI: 8.7 to 10.0; P < 0.0001).
The study’s primary outcome was all-cause dementia, which was found to be significantly lower in the intervention group compared to the usual care group, with a risk ratio of 0.85 (95% CI: 0.76 to 0.95; P = 0.0035). Additionally, the intervention group experienced fewer serious adverse events, with a risk ratio of 0.94 (95% CI: 0.91 to 0.98; P = 0.0006). These results suggest that more intensive BP management, especially in hypertensive patients, is effective in reducing the incidence of dementia and cognitive impairment.
The study underscores the importance of early and proactive BP control in reducing dementia risk, particularly in low- and middle-income countries where hypertension is prevalent. The findings advocate for the widespread adoption of BP-lowering strategies as part of dementia prevention, emphasizing their role in addressing the global burden of dementia and cognitive decline.
Link to the article: https://www.nature.com/articles/s41591-025-03616-8
References He, J., Zhao, C., Zhong, S., Ouyang, N., Sun, G., Qiao, L., Yang, R., Zhao, C., Liu, H., Teng, W., Liu, X., Wang, C., Liu, S., Chen, C.-S., Williamson, J. D., & Sun, Y. (2025). Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: An open-label, blinded-endpoint, cluster-randomized trial. Nature Medicine, 1–8. https://doi.org/10.1038/s41591-025-03616-8
