Intensive BP intervention reduces risk of dementia 

An intensive blood pressure (BP) intervention outperformed usual care in reducing the risk of dementia in patients (n=33,995) with hypertension living in rural Chinese villages. “The proven-effective intervention should be scaled up widely to reduce the global burden of dementia,” stated Dr Jiang He (Tulane University, LA, USA), who presented the main results of the study. 

Dr He and colleagues compared the effectiveness of an intensive BP intervention to usual care on the risk reduction of dementia in patients with hypertension in a cluster-randomised trial [1]. The 33,995 participants with hypertension from 326 rural Chinese villages were randomised 1:1. The experimental BP intervention included doctor-initiated titration of anti-hypertensive drugs, the delivery of discounted and free medications to patients, lifestyle interventions, education on BP monitoring, and medication adherence instructions. The primary outcome was all-cause dementia at 48 months.

“In the usual-care arm, the systolic BP had dropped by a mean of 7.2 mmHg, and this measure was by a mean of 29.2 mmHg in the experimental arm,” said Dr He. For diastolic BP, the corresponding rates were -6.1 mmHg and -15.4 mmHg. In addition, 67.7% of the participants in the intervention arm were normotensive at 48 months compared with 15.0% in the usual-care arm (P<0.0001). Not surprisingly, those in the intervention arm were on a higher number of anti-hypertensive agents (mean 3.0 vs 1.2; P<0.0001). “Importantly, the primary outcome was met, with an annual rate of 1.12% of all-cause dementia in the intervention arm and a rate of 1.31% in the usual-care arm, representing a 15% reduction,” said Dr He (RR 0.85; 95% CI 0.76–0.95; P=0.0035).

“This is the first definitive evidence from a randomised-controlled trial showing the effect of a BP-lowering intervention on dementia risk reduction,” Dr Daniel Jones (University of Mississippi, MS, USA) congratulated the study authors. “Next, we have to investigate whether intensive BP reduction decreases the risk for all forms of dementia. Also, the role of BP in the pathophysiology of Alzheimer's disease, vascular dementia, and other forms of dementia needs to be studied.” Finally, Dr Jones expressed that it would be interesting to investigate whether earlier intervention offers more protection.

1. 
   
   1. He J, et al. Effectiveness of blood pressure lowering intervention on risk of total dementia among patients with hypertension: a cluster-randomised effectiveness trial. LB04, AHA Scientific Sessions 2023, 11–13 November, Philadelphia, USA.

Copyright ©2024 Medicom Medical Publishers



Posted on 29 January 202413 June 2024