INTENSIVE blood pressure (BP) control in patients with hypertension reduces the risk of all-cause dementia by 15%, according to the CRHCP-3 cluster-randomised trial involving 33,995 individuals in rural China, published in Nature Medicine.
Dementia, a leading global cause of disability and death, is projected to affect over 150 million people by 2050, with hypertension identified as a modifiable risk factor. This study tested whether a non-physician-led BP intervention could mitigate dementia risk in underserved populations. Participants aged ≥40 with untreated hypertension (BP ≥140/90 mmHg or ≥130/80 mmHg for high-risk individuals) were randomised to intervention or usual care. The intervention group received antihypertensive medication titrated by village doctors to target BP <130/80 mmHg, alongside health coaching on lifestyle changes and medication adherence. Usual care involved standard hypertension management under China’s rural health insurance scheme.
Over 48 months, the intervention group achieved a net systolic BP reduction of 22.0 mmHg (95% CI 20.6–23.4; P<0.0001) and diastolic BP reduction of 9.3 mmHg (95% CI 8.7–10.0; P<0.0001) compared to controls. All-cause dementia incidence was 15% lower in the intervention group (risk ratio [RR]=0.85; 95% CI 0.76–0.95; P=0.0035), with cognitive impairment without dementia reduced by 16% (RR=0.84; 95% CI 0.80–0.87; P<0.0001). Serious adverse events were also less frequent in the intervention group (RR=0.94; 95% CI 0.91–0.98; P=0.0006). These results align with the SPRINT-MIND trial, reinforcing BP control as a dementia prevention strategy.
These findings underscore the critical role of accessible, community-based BP management in reducing dementia burden. Clinicians should prioritise aggressive BP targets (<130/80 mmHg) using existing antihypertensives, particularly in low-resource settings where non-physician providers can effectively deliver care. Future policies must scale such interventions globally, while research explores long-term benefits and mechanisms linking BP reduction to cognitive protection.
Reference
Jiang He J et al. Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial. Nature Medicine. 2025;DOI: 10.1038/s41591-025-03616-8.
