Intensive BP Control Cuts Dementia Risk By 15% in CRHCP Trial

An intensive blood pressure-lowering intervention delivered by non-physician community healthcare providers reduced the incidence of dementia by 15% over 7 years compared with usual care, according to results from the China Rural Hypertension Control Program (CRHCP) presented in a Hot Line session at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany.¹

The number of people living with dementia globally is projected to rise from 57 million in 2019 to 153 million by 2050, and in the absence of curative treatment, primary prevention has become a public health priority.²

"Hypertension is known to be a modifiable risk factor for dementia but there is still limited long-term evidence that blood-pressure lowering can prevent dementia at the population level," said Yingxian Sun, The First Affiliated Hospital of China Medical University, Principal Investigator of the CRHCP.

CRHCP previously demonstrated the intervention reduced cardiovascular disease and death, and this analysis assessed whether it could also reduce all-cause dementia.³

CRHCP Trial Design and Dementia Outcomes at 7 Years

In CRHCP, a cluster-randomized trial, 326 rural Chinese villages were randomly assigned in a 1:1 ratio to a non-physician community healthcare provider-led intervention or usual care.¹ Eligible participants were adults ≥ 40 years of age with an untreated systolic blood pressure (SBP) of ≥ 140 mmHg or diastolic blood pressure (DBP) of ≥ 90 mmHg, or 130/80 mmHg for those at high cardiovascular risk or already taking antihypertensive medication.¹

In the intervention group, trained non-physician community healthcare providers initiated and titrated antihypertensive medications according to a stepped-care protocol to achieve a goal of SBP < 130 mmHg and DBP < 80 mmHg, with supervision from primary care physicians.¹

The active trial phase lasted 4 years, followed by 3 additional years of observation, for a total of 7 years. Investigators enrolled 33,995 participants with a mean age of 63.0 years, and 61% were female. At 7 years, the intervention group had greater blood pressure reductions from baseline than the usual-care group (SBP reduction of 17.6 mmHg vs 2.4 mmHg).¹

The intervention group had a 15% lower risk of dementia than the usual-care group at 7 years (8.85% vs 10.55%; adjusted risk ratio, 0.85; 95% CI, 0.78-0.91; P <.001), along with a 13% lower risk of cognitive impairment without dementia (P <.001).¹ Serious adverse events were also less frequent with the intervention than with usual care (47.15% vs 49.78%).¹

How CRHCP Compares With Prior Blood Pressure and Dementia Evidence

CRHCP's dementia finding contrasts with the largest prior randomized evidence on this question. SPRINT MIND, a substudy of the US-based SPRINT trial, found intensive systolic blood pressure control (target < 120 mmHg) significantly reduced mild cognitive impairment but fell short of statistical significance for probable dementia alone (hazard ratio, 0.83; 95% CI, 0.67-1.04), a result attributed in part to the trial's active treatment phase being stopped early for cardiovascular benefit.⁴ CRHCP, conducted over a longer active and observational period in a larger population, reached statistical significance for dementia as a standalone outcome.

Shanshan Zhong, MD, investigator and presenter, also of The First Affiliated Hospital of China Medical University, noted establishing this endpoint was a specific aim of the program. "Another important aim of the CRHCP was to assess whether intensive blood-pressure lowering can reduce the incidence of all-cause dementia," he said.¹

Sun said the results support integrating structured blood pressure management into routine primary care: "In this large community-based trial, a scalable intervention delivered by non-physician healthcare providers not only resulted in substantial reductions in blood pressure but also reduced the risk of dementia," he said. "These results support the long-term sustainability of integrating structured blood pressure management into routine primary care for dementia prevention at the population level."

References

1. European Society of Cardiology. Long-term intensive blood-pressure control reduces dementia risk. Published August 30, 2026. Accessed August 30, 2026. https://www.escardio.org/news/press/press-releases/long-term-intensive-blood-pressure-control-reduces-dementia-risk/

2. Zhang Z, Han S, Zhu H, et al. Global, regional, and national burden of early-onset Alzheimer's disease and other dementias in young adults aged 40-64 years, 1990-2021: a population-based study. Eur J Neurol. 2025;32:e70116.

3. He J, Ouyang N, Guo X, et al. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet. 2023;401:928-938.

4. Williamson JD, Pajewski NM, Auchus AP, et al; SPRINT MIND Investigators for the SPRINT Research Group. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019;321(6):553-561. doi:10.1001/jama.2018.21442