Intensive BP intervention reduces risk of dementia

An intensive blood pressure (BP) intervention outperformed usual care in reducing the risk of dementia in patients with hypertension living in rural Chinese villages. “The proven-effective intervention should be scaled up widely to reduce the global burden of dementia,” according to 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. The 33,995 participants with hypertension from 326 rural Chinese villages were randomised 1:1 to usual care or an intensive intervention. The experimental intervention included doctor-initiated titration of anti-hypertensive drugs, the deliverance 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 with a mean 7.2 mmHg, and in the experimental arm, this measure was reduced with a mean 29.2 mmHg,” 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 experimental 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 experimental arm and a rate of 1.31% in the control arm (RR 0.85; 95% CI 0.76–0.95; P=0.0035), representing a 15% reduction,” according to Dr He.

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   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, 10–12 November, Philadelphia, USA.

 

Medical writing support was provided by Robert van den Heuvel.
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Posted on 14 November, 202315 November, 2023