Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial.

Summary

In a cluster-randomized, open-label trial with blinded endpoint adjudication across 327 villages (n=33,995), non-physician-led intensive BP management achieved net −22/−9.3 mmHg reductions and reduced all-cause dementia (RR 0.85) over 48 months versus usual care. Serious adverse events were also lower (RR 0.94).

Key Findings

• Net BP reduction of −22.0 mmHg systolic and −9.3 mmHg diastolic over 48 months with non-physician-led care versus usual care.
• All-cause dementia significantly reduced (risk ratio 0.85; 95% CI 0.76–0.95).
• Serious adverse events were lower in the intervention group (risk ratio 0.94; 95% CI 0.91–0.98).

Clinical Implications

Supports adopting intensive BP targets (<130/80 mmHg) with team-based, non-physician-led protocols to reduce dementia risk in hypertensive populations, especially in resource-limited settings.

Limitations

• Open-label design and cluster-level allocation may introduce performance or contextual biases.
• Generalizability beyond rural China and ascertainment of dementia subtypes were not detailed.

Future Directions

Assess dementia subtype-specific effects, cost-effectiveness, and implementation strategies across diverse health systems; explore optimal BP targets for cognitive outcomes.