
May 14, 2025
Need extra incentive to keep your blood pressure under control and to take your daily blood pressure medications? One of the largest and most comprehensive studies to date found that keeping your blood pressure in check can substantially lower your risk of developing dementia. It can also help to preserve your thinking and memory skills.
“Our study is one of the first large-scale, randomized controlled effectiveness trials to demonstrate a significant reduction in all-cause dementia associated with lowering blood pressure,” wrote Dr. Jiang He, the study’s lead author and a professor in the Department of Epidemiology at the University of Texas Southwestern Medicine Center in Dallas.
High blood pressure not only increases the risk of heart attacks and strokes but is a well-recognized risk factor for Alzheimer’s disease. Alzheimer’s disease remains the most common form of dementia worldwide, accounting for an estimated 60 to 80 percent of cases overall.
Earlier studies had shown a strong link between high blood pressure and dementia onset, especially vascular dementia, marked by damage to blood vessels that supply oxygen and nutrients to the brain. Many people with Alzheimer’s disease also have some degree of vascular dementia as well.
But most of those studies were observational, looking at groups of patients at different snapshots in time. This new study directly compared two groups of patients with high blood pressure that underwent different treatments for multiple years. One group was randomly assigned to receive blood pressure meds and carefully monitored to get their blood pressure numbers down, while the other group received standard care. The authors had previously reported preliminary results at an American Heart Association conference, but this analysis included additional follow-up and peer review. The findings were published in the journal Nature Medicine.
For the current study, researchers looked at 33,995 men and women ages 40 and older with untreated high blood pressure who were living in 326 rural villages in China. Their average age was 63. All were part of an ongoing study called the China Rural Hypertension Control Project Phase 3, or CRHCP-3. Their blood pressures were high: on average, about 156/87.
Blood pressure is recorded as two numbers: the systolic pressure, or top number, as the heart contracts; and the diastolic pressure, or bottom number, when the heart is at rest. A healthy blood pressure is generally regarded as 120/80.
The study participants were randomly divided into two groups, according to where they lived. In half the villages, community health care workers, often known as “village doctors,” provided comprehensive blood pressure monitoring and management. Participants were put on one or more free or low-cost blood pressure medications, with dosages adjusted to help bring systolic pressure to below 130 and diastolic pressure to under 80. The health care workers also provided health coaching about the importance of monitoring blood pressure at home, taking your medications, and adopting lifestyle changes known to help control blood pressure, such as weight loss, dietary sodium restriction, and reducing alcohol.
Residents in the other villages received usual care, including monitoring of blood pressure during their normal clinic visits and recommendations about blood pressure control. While some took blood pressure medications, this group did not receive free or affordable blood pressure drugs or home blood pressure monitors.
The participants were followed for about four years. During that time, blood pressures in those getting the intensive treatments fell, on average, from 157/128 to 88/73. In the usual care group, blood pressure dropped from 155/87, to 148/81. Participants were also given regular cognitive assessments to detect dementia or other declines in thinking and memory skills.
By the end of the study period, those in the intensive blood pressure management group fared far better when it came to brain health. After four years, intensive management of blood pressure through medications and lifestyle changes cut the risk of dementia by 15 percent, and the risk of cognitive problems by 16 percent, compared to those receiving usual care.
“The CRHCP-3 trial provides strong evidence for the effectiveness of antihypertensive treatment in reducing the risk of dementia in patients with hypertension,” the authors concluded. “This proven-effective intervention should be widely adopted and scaled up to reduce the global burden of dementia.”
While the first-line treatment for high blood pressure is regular exercise and a heart-healthy diet, blood pressure medications may be especially important for maintaining memory and thinking skills as we age, as this study confirms. If your doctor prescribes blood pressure drugs, it is important to keep taking them and to have your blood pressure checked regularly.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Eric Schmidt, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Jiang He, Chuansheng Zhao, Shanshan Zhong, et al: “Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial.” Nature Medicine, April 2025