Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label,...

Area of Science:

• Gerontology and Geriatric Medicine
• Cardiovascular Disease Research
• Neurology and Neurodegenerative Disorders

Background:

• Dementia poses a significant global health challenge, leading to widespread death and disability.
• Uncontrolled hypertension is a major modifiable risk factor for dementia.
• Effective strategies for blood pressure management in diverse populations are crucial for dementia prevention.

Purpose of the Study:

• To evaluate the effectiveness of a community healthcare provider-led intervention for intensive blood pressure reduction on the risk of all-cause dementia.
• To assess the impact of a stepped-care antihypertensive medication protocol on dementia incidence in individuals with uncontrolled hypertension.

Main Methods:

• A cluster-randomized trial involving 33,995 individuals aged ≥40 years with uncontrolled hypertension in rural China.
• Intervention group: Non-physician community healthcare providers managed antihypertensive medications aiming for systolic BP <130 mmHg and diastolic BP <80 mmHg.
• Control group: Received usual care; intervention group received stepped-care protocol with physician supervision over 48 months.

Main Results:

• The intervention group achieved a net systolic BP reduction of 22.0 mmHg and diastolic BP reduction of 9.3 mmHg compared to usual care.
• All-cause dementia incidence was significantly lower in the intervention group (Risk Ratio: 0.85; 95% CI: 0.76–0.95; P=0.0035).
• Serious adverse events were less frequent in the intervention group (Risk Ratio: 0.94; 95% CI: 0.91–0.98; P=0.0006).

Conclusions:

• Intensive blood pressure reduction, facilitated by non-physician healthcare providers using a stepped-care protocol, effectively lowers the risk of all-cause dementia.
• This intervention demonstrates a successful public health strategy for dementia prevention in hypertensive populations.
• The findings support the integration of community-based management for hypertension control to mitigate dementia risk.