In a community-based trial in rural China, an intensive blood-pressure lowering intervention reduced the incidence of dementia compared with usual care, according to results from the China Rural Hypertension Control Program presented in a Hot Line session today at ESC Congress 2026.
It is estimated that the number of people with dementia will increase globally from 57 million cases in 2019 to 153 million cases in 2050. In the absence of curative treatment, primary prevention of dementia is becoming a public health priority.
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.”
Professor Yingxian Sun from The First Affiliated Hospital of China Medical University, Shenyang, China, the Principal Investigator of the China Rural Hypertension Control Program (CRHCP)
CRHCP is a cluster-randomized trial assessing the efficacy of an intensive blood pressure intervention led by non-physician community healthcare providers. It has already been demonstrated that the intensive blood pressure intervention is effective at reducing cardiovascular disease and death. “Another important aim of the CRHCP was to assess whether intensive blood-pressure lowering can reduce the incidence of all-cause dementia,” noted investigator and presenter, Doctor Shanshan Zhong, also from The First Affiliated Hospital of China Medical University.
In the CRHCP, 326 rural Chinese villages were randomized (1:1) to a non-physician community healthcare provider-led intervention or usual care. Eligible participants were adults aged 40 years or more with an untreated systolic blood pressure (SBP) of at least 140 mmHg or a diastolic blood pressure (DBP) of at least 90 mmHg (at least 130 mmHg and 80 mmHg for those at high risk of cardiovascular disease or if currently taking antihypertensive medication). In the intervention group, trained non-physician community healthcare providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a blood pressure goal of SBP less than 130 mmHg and DBP less than 80 mmHg with supervision from primary-care physicians. The active trial phase lasted for four years, followed by three additional years of observation only. In total, 33,995 participants were enrolled who had a mean age of 63.0 years; 61% were women.
The intervention group had greater reductions in blood pressure from baseline vs. the usual care group at the end of the seven-year study period (SBP reductions of 17.6 mmHg vs. 2.4 mmHg).
Of note, the intervention group had a 15% lower risk of dementia than the usual-care group at seven years (8.85% vs. 10.55%; adjusted risk ratio 0.85; 95% confidence interval 0.78 to 0.91; p<0.001). The intervention group also had a 13% lower risk of cognitive impairment and no dementia (p<0.001).
The proportion of patients with serious adverse events was also less with the intervention than usual care (47.15% vs. 49.78%).
“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,” summarized Professor Sun, who concluded, “These results support the long-term sustainability of integrating structured blood pressure management into routine primary care for dementia prevention at the population level.”
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