Intervention for uncontrolled hypertension also lowers dementia risk
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Key takeaways:
- The number of people with dementia worldwide is projected to rise to 152.8 million in 2050.
- An intensive BP-lowering strategy also reduced risk for dementia, cognitive impairment and serious adverse events.
PHILADELPHIA — A 48-month intervention to lower BP in patients with uncontrolled hypertension also reduced risk for dementia and cognitive impairment, according to data presented at the American Heart Association Scientific Sessions.
“In the absence of curative treatment, the primary prevention of dementia through risk factor reduction, such as blood pressure-lowering, becomes a public health priority. Previous randomized controlled trials reported a nonsignificant reduction in dementia associated with antihypertensive treatment in patients with stroke or hypertension,” Jiang He, MD, PhD, FAHA, professor of epidemiology and medicine and director of Tulane University’s Translational Science Institute, said during a presentation. “We aimed to test the effectiveness of an intensive blood pressure intervention compared to usual care in reducing the risk of all-cause dementia and cognitive impairment among patients with hypertension over a 48-month intervention period.”
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Researchers enrolled 33,995 individuals aged 40 years or older with uncontrolled hypertension — defined as BP of 140/90 mm Hg or more — across 326 villages in China (mean age, 63 years; 61% women; 23% with less than primary school education).
Overall, 163 villages were randomly assigned to a nonphysician community health care provider-led intervention and the remainder received usual care.
With supervision from primary care physicians, the intervention consisted of trained nonphysician community health care providers who initiated and titrated antihypertensive medications based on a simple stepped-care protocol. Discounted or free antihypertensive medications, health coaching for lifestyle modification and medication adherence and guidance on home BP monitoring were also provided.
The goal was systolic BP below 130 mm Hg and a diastolic BP below 80 mm Hg.
The primary outcome was all-cause dementia adjudicated by two independent neurologists who were masked to intervention assignments.
Overall, 39,044 participants completed the 48-month follow-up.
At final follow-up, the net change in the intervention arm was 22 mm Hg systolic (95% CI, 23.4 to 20.6; P < .0001) and 9.3 mm Hg diastolic (95% CI, –10 to –8.7; P < .0001), according to the results.
At 48 months, 67.7% of the intervention group achieved BP less than 130/80 mm Hg compared with 15% of the standard care group.
The per-year occurrence of all-cause dementia was significantly lower in the intervention arm compared with the usual care arm (1.12% vs. 1.31%) and the relative risk for dementia was 15% lower in the intervention group (RR = 0.85; 95% CI, 0.76-0.95; P = .0035).
Risk for secondary cognitive outcomes including adjudicated cognitive impairment without dementia (RR = 0.84; P < .0001), cognitive impairment or dementia (RR = 0.84; P < .0001), dementia or all-cause death (RR = 0.86; P < .0001) and serious adverse events (RR = 0.94; P = .0006) were lower in the intervention group compared with usual care.
It is estimated that the number of individuals with dementia worldwide will increase from 57.4 million in 2019 to 152.8 million in 2050, according to He.
“Blood pressure reduction is effective in reducing the risk of dementia in patients with hypertension. This proven, effective intervention should be widely scaled up to reduce the global burden of dementia,” He said.
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He J, et al. LBS.04. Using drugs, diet and delivery to optimize hypertension outcomes. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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