Reduce Dementia Risk by Lowering Blood Pressure in Hypertension Patients

Key Research Findings:

• A blood pressure intervention program in rural China spanning four years significantly reduced systolic blood pressure by an average of 22 mmHg and lowered the risk of all-cause dementia by 15% in individuals with high blood pressure.
• Village doctors, trained as interventionists, initiated and titrated antihypertensive medications based on a simple protocol, aiming for a target blood pressure of less than 130/80 mm Hg.
• These village doctors provided discounted and gratis medications, and conducted health coaching on lifestyle modifications, home blood pressure measurement, and adherence to medication.

Intensive Blood Pressure Intervention Reduces Dementia Risk

An intensive four-year blood pressure intervention significantly reduced the risk of developing dementia in adults with high blood pressure, according to a study reported at the American Heart Association’s Scientific Sessions 2023. This event, held in Philadelphia, showcased the latest advancements and research in cardiovascular science.

“Primary prevention of dementia through the reduction of risk factors has become a public health priority,” stated Jiang He, M.D., Ph.D., FAHA. “Previous studies have found that individuals with untreated hypertension have a 42% increased risk of dementia compared with healthy adults, while those with treated hypertension have no significant increase in dementia risk.”

The study was implemented in 326 villages in rural China and included about 34,000 adults who had untreated blood pressure of 140/90 mm Hg or higher, or 130/80 mm Hg or higher for people at high risk for cardiovascular disease or those on blood pressure medication. Half of the villages were randomly assigned to a village doctor-led intensive blood pressure intervention strategy, while the rest received usual care.

Significant Results from the Intervention

At the end of the study, the intervention group showed significant improvement in blood pressure control and reduced dementia. Some notable findings include:

• The average blood pressure in the intervention group after 48 months was 128/73 mm Hg, compared to 148/81 mm Hg in the usual care group.
• Systolic blood pressure decreased by 22 mm Hg on average, and diastolic blood pressure decreased by 9 mm Hg among the intervention group compared to usual care.
• The intervention group had a 15% lower risk of dementia and a 16% lower risk of memory impairment compared to the group that received usual care.
• Serious adverse events, such as hospitalizations and deaths from all causes, were also less frequent in the intervention group.

“This is the first large randomized trial to demonstrate that lowering blood pressure effectively reduces the risk of dementia in people with high blood pressure,” He said. “These findings emphasize the necessity of wider adoption of more intensive blood pressure control to reduce the global burden of dementia.”

Study Details and Limitations

• The trial began in May 2018 and concluded in March 2023.
• The average age of participants was 63 years old with a majority of women (61%). Similar reductions in blood pressure and dementia risk were observed in both genders.

A limitation of the study was that researchers did not assess participants’ cognitive function during baseline examinations. Future research is required to test whether lowering blood pressure will reduce the risk of dementia among adults with a high risk for dementia but without high blood pressure.

According to the American Heart Association, nearly half of adults in the U.S. have high blood pressure, indicating the dire need for interventions such as this to combat the growing problem.