Summary: A large cluster-randomized trial in rural China found that intensive blood pressure control substantially reduced the risk of dementia and cognitive decline in people with uncontrolled hypertension. Over 48 months, participants who received a targeted intervention had a 15% lower risk of all-cause dementia and a 16% lower risk of cognitive impairment without dementia, compared with usual care.
The intervention deployed non-physician community healthcare providers to help patients reach a blood pressure target below 130/80 mm Hg. These results support broader use of intensive blood pressure management as a scalable strategy to reduce the global burden of dementia.
Key Facts:
- Meaningful reduction: Intensive blood pressure lowering was associated with a 15% reduced risk of all-cause dementia.
- Large, real-world study: The trial enrolled 33,995 adults across 326 villages in rural China.
- Community-based delivery: Non-physician community healthcare providers led medication initiation and titration using a simple stepped-care protocol to reach SBP <130 mm Hg and DBP <80 mm Hg.
Source: Liaoning Clinical Research Center for Hypertensive Diseases
Background: Dementia is a leading cause of death and disability worldwide. With no curative treatments available, preventing dementia by addressing modifiable risk factors—such as hypertension—has become a global public health priority. Until now, definitive evidence that lowering blood pressure prevents dementia among people with hypertension has been limited.
To address this gap, researchers from multiple institutions organized the China Rural Hypertension Control Project Phase-3 (CRHCP-3), one of the largest randomized effectiveness trials focused on blood pressure management and cognitive outcomes.
Study design and intervention: The trial included 33,995 adults aged 40 and older with uncontrolled hypertension across 326 villages. Researchers randomized 163 villages to the intervention and 163 to usual care. In intervention villages, trained non-physician community healthcare providers (NPCHPs) initiated and titrated antihypertensive medications under supervision of primary care physicians, following a stepped-care approach aimed at achieving a systolic blood pressure (SBP) below 130 mm Hg and diastolic blood pressure (DBP) below 80 mm Hg.
Primary outcomes and results: After 48 months, the intervention group achieved a mean SBP reduction of 22.0 mm Hg and a mean DBP reduction of 9.3 mm Hg compared with the usual care group. The primary outcome—all-cause dementia—was significantly lower in the intervention arm (risk ratio 0.85, 95% CI 0.76–0.95; P = 0.0035). Cognitive impairment without dementia (CIND) was also reduced by about 16%. Serious adverse events occurred slightly less often in the intervention group (risk ratio 0.94; 95% CI 0.91–0.98; P = 0.0006).
Implications: These findings indicate that intensive blood pressure reduction, delivered by trained community healthcare workers using a practical protocol, can lower the risk of dementia in people with hypertension. The results strengthen the case for integrating more aggressive blood pressure targets into community-based hypertension programs—particularly in low-resource settings—both to prevent cardiovascular disease and to reduce the future burden of dementia.
“These results 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 Yingxian Sun, professor at the First Hospital of China Medical University and an author of the study.
The research team noted plans to apply big data and artificial intelligence in future work to improve early prediction of dementia and to tailor prevention and treatment strategies for individuals.
Study team and collaborators: Major contributors included investigators from UT Southwestern Medical Center, the First Hospital of China Medical University (Departments of Neurology and Cardiology), Hanzhong People’s Hospital, Tongji Medical College of Huazhong University of Science and Technology, Tulane University Translational Science Institute, Wake Forest University, and other institutions. Key authors listed in the original report include Jiang He, Chuansheng Zhao, Shanshan Zhong, Huayan Liu, Weiyu Teng, Xu Liu, Nanxiang Ouyang, Guozhe Sun, Lixia Qiao, Chang Wang, Songyue Liu, Yingxian Sun, Ruihai Yang, Chunxia Zhao, Chung-Shiuan Chen and Jeff D. Williamson.
Funding: The trial was supported by 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.
About this hypertension and dementia research news
Author: Zongmei Song (email: [email protected])
Source: Liaoning Clinical Research Center for Hypertensive Diseases
Contact: Zongmei Song – Liaoning Clinical Research Center for Hypertensive Diseases
Image: The image is credited to Neuroscience News
Original Research: Closed access. “Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial” by Yingxian Sun et al., Nature Medicine (April 2025). DOI: 10.1038/s41591-025-03616-8
Abstract
Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial
This cluster-randomized trial tested the effectiveness of blood pressure reduction on the risk of all-cause dementia among 33,995 individuals aged 40 years and older with uncontrolled hypertension in rural China. Trained non-physician community healthcare providers led medication initiation and titration according to a stepped-care protocol to achieve SBP <130 mm Hg and DBP <80 mm Hg, with supervision from primary care physicians. Over 48 months, the net reduction in SBP was 22.0 mm Hg (95% CI 20.6 to 23.4; P < 0.0001) and in DBP was 9.3 mm Hg (95% CI 8.7 to 10.0; P < 0.0001) in the intervention group compared with usual care. All-cause dementia incidence was significantly lower in the intervention group (risk ratio 0.85; 95% CI 0.76 to 0.95; P = 0.0035), and serious adverse events were slightly less frequent (risk ratio 0.94; 95% CI 0.91 to 0.98; P = 0.0006). ClinicalTrials.gov: NCT03527719.