Blood Pressure Reduction Linked to Lower Dementia Risk in Large-Scale China Trial

A groundbreaking study conducted in rural China has revealed that lowering blood pressure can significantly reduce the risk of dementia in patients with hypertension. The findings, published in Nature Medicine on April 21, 2025, stem from phase 3 of the China Rural Hypertension Control Project (CRHC), led by cardiologist Yingxian Sun, M.D., Ph.D., of First Hospital of China Medical University in Shenyang.

Study Design and Key Findings

The randomized trial involved nearly 34,000 participants from 326 villages, divided into two groups. One group received usual hypertension care, while the other underwent intensive treatment for blood pressure reduction. After four years, the results were striking:

• 4.59% of patients in the intensive treatment group developed dementia, compared to 5.4% in the usual care group.
• 17.2% of patients in the intensive blood pressure lowering group developed cognitive impairment without dementia (CIND), versus 20.7% in the usual care group.
• The reduction in blood pressure was associated with a 15% lower risk of all-cause dementia and a 16% lower risk of CIND.

Dr. Sun and colleagues concluded, "The CRHCP-3 trial provides strong evidence for the effectiveness of antihypertensive treatment in reducing the risk of dementia in patients with hypertension."

Intervention Methodology

The intensive hypertension treatment involved a comprehensive approach:

• Community healthcare providers, often referred to as village doctors, administered antihypertensive medications.
• Patients received coaching on lifestyle changes.
• Rigorous blood pressure monitoring ensured levels remained within the targeted lower range.

In contrast, patients in the usual care group did not receive antihypertensive medications or at-home blood pressure monitoring devices.

Global Implications for Dementia Prevention

This study adds to a growing body of evidence linking hypertension management to dementia risk reduction. A 2023 analysis of 17 studies, encompassing 34,589 participants, found that older adults with uncontrolled hypertension were 42% more likely to develop dementia than those whose hypertension was treated.

The World Health Organization reports that 57 million people worldwide were affected by dementia in 2021. As the leading cause of death in the UK, dementia has spurred efforts to fund new treatments and explore potential preventive measures, including investigating a possible link between GSK's shingles vaccine and reduced dementia risk.

The CRHC phase 3 trial stands out as a randomized study specifically designed to test the effect of lowering blood pressure on dementia risk, providing more robust evidence than previous observational studies or those that measured dementia risk as a secondary outcome.

As the global healthcare community grapples with the rising prevalence of dementia, these findings offer promising insights into potential prevention strategies through improved hypertension management.