Long-term blood pressure control reduces dementia risk

Intensive efforts to maintain low blood pressure can lower the incidence of dementia, according to a trial in rural China which was delivered by non-physician healthcare providers.

Headline results from the China Rural Hypertension Control Program (CRHCP) were presented at ESC Congress 2026. Researchers found that, over a seven-year period, blood pressure intervention resulted in a 15% reduction in dementia compared with usual care.

The number of people with dementia is expected to increase globally from 57 million cases in 2019 to 153 million cases in 2050. In the absence of a cure, primary prevention of dementia is becoming a public health priority.

‘Hypertension is a modifiable risk factor for dementia but there is still limited long-term evidence that blood-pressure lowering can prevent dementia at the population level,’ said Prof Yingxian Sun, the Principal Investigator of the CRHCP.

The cluster-randomised trial assessed the efficacy of an intensive blood pressure intervention led by community health workers. It has already been demonstrated that intensive blood pressure control is effective at reducing cardiovascular disease and death. ‘Another important aim of the CRHCP was to assess whether intensive blood-pressure lowering can reduce the incidence of all-cause dementia,’ said Dr Shanshan Zhong from The First Affiliated Hospital of China Medical University.

Researchers randomised 326 rural Chinese villages to a non-physician intervention or usual care. Eligible participants were adults aged 40 years or more with an untreated systolic blood pressure (SBP) of at least 140 mmHg or a diastolic blood pressure (DBP) of at least 90 mmHg (at least 130 mmHg and 80 mmHg for those at high risk of cardiovascular disease or if currently taking antihypertensive medication).

In the intervention group, trained community healthcare providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve the blood pressure goal with supervision from primary-care physicians. The active trial phase lasted for four years, followed by three additional years of observation only. In total, 33,995 participants were enrolled who had a mean age of 63.0 years. Approximately 61% were women.

The intervention group had greater reductions in blood pressure from baseline compared to the usual care group at the end of the seven-year study period (SBP reductions of 17.6 mmHg versus 2.4 mmHg). Of note, the intervention group had a 15% lower risk of dementia than the usual-care group at seven years. The intervention group also had a 13% lower risk of cognitive impairment.

‘In this large community-based trial, a scalable intervention delivered by non-physician healthcare providers not only resulted in substantial reductions in blood pressure but also reduced the risk of dementia,’ said Professor Sun. ‘These results support the long-term sustainability of integrating structured blood pressure management into routine primary care for dementia prevention at the population level.’