Elizabeth Cooney , 2025-04-21 15:00:00
High blood pressure earned its reputation as the silent killer by causing heart attacks, heart failure, and strokes.
It’s also been a suspect in dementia. Some studies have hinted at a correlation between lower blood pressure and fewer dementia cases, but they were too small and too short to lend statistical significance to the link. It’s also been noted that people with untreated high blood pressure carry a 42% higher risk of developing dementia.
Now a new study published Monday in Nature Medicine reports that intensive blood pressure control lowered the risk of dementia by 15% and cognitive impairment by 16%. The large, cluster-randomized trial in rural China once again illuminated the role of “village doctors,” the local term for community health workers, who outdid usual care.
“This is an incredibly important study,” Dan Jones, a past president of the American Heart Association, told STAT. He was not involved in the new research. “Here’s something tangible that now we can tell our patients. This is so important for motivating people to control their blood pressure, and treating it intensively as well.”
The trial included nearly 34,000 people age 40 and older in rural China who had untreated hypertension. Just over half of the people received care from community health workers who started them on blood pressure medications, adjusting the drugs and the doses as needed to reach a goal of bringing blood pressure below 130/80 mm Hg. These non-physicians also gave participants discounted or free antihypertensive medications and coached them on home blood pressure monitoring, lifestyle changes (such as weight loss, reducing dietary sodium, and limiting alcohol), and medication adherence.
Whole villages were in either the intervention group or the control group, whose members received usual care from their health care providers to reach a more modest target blood pressure of below 140/90 mm Hg. People who got more intensive guidance in the intervention villages took an average of three different blood pressure drugs, compared to one that people in the control villages were given.
After four years, the intervention group achieved better blood pressure control as well as a 15% reduction in dementia and a 16% reduction in cognitive impairment.
“Our study is the first to report a statistically significant reduction in the risk of all-cause dementia associated with antihypertensive treatment, providing strong evidence to support its use for the primary prevention of dementia,” study author Jiang He, a physician and professor of epidemiology at UT Southwestern, told STAT in an email.
The non-physician community health care providers have garnered attention before for their success at controlling blood pressure and reducing risk for cardiovascular disease. Well-trained but not M.D.s, they’ve helped thousands of people living with high blood pressure in rural regions, studies in the Lancet in 2022 and JAMA Cardiology in 2024 focused on cardiovascular risk have said.
Village doctors are seen as key players in places with lower income, Jones wrote in an editorial that appeared with the JAMA Cardiology paper.
“This focus on low-resource settings would be a comprehensible recommendation if hypertension control rates were much better in high-resource settings, such as in the U.S. This is not the case. Might it be that this simple approach would be useful not only in low-resource settings but in high-resource settings as well?”
Nearly half of American adults have blood pressure higher than 130/80 mm Hg, three-quarters of whom do not have it under control, the Centers for Disease Control and Prevention says. Much like the village doctors in China, community health workers lowered blood pressure among certain populations in New York, this 2023 study demonstrated. But an effort in Maryland and Pennsylvania had mixed results, a 2024 study reported.
Next research steps might be longer studies in different populations with more frequent cognitive assessments, the paper’s authors and outside experts suggested.
“It is encouraging that the intervention worked in real-world, rural settings using non-physician healthcare workers. However, this four-year study cannot tell us whether the benefits will last in the long-term,” Richard Oakley, associate director of research and innovation at the U.K.’s Alzheimer’s Society, said in a statement. “Although no single behaviour is guaranteed to prevent dementia, we know that what’s good for your heart is often also good for your head.”
The study’s strength in establishing cause and effects helps solidify what’s been advanced before as a correlation.
“It would take a lot of money, a lot of years, but I think if you take the results of this study and extrapolate to what it might mean for younger and middle-aged patients, the impact could really be astounding,” Jones said. “But you have to do the studies to know that for sure.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
