BP lowering reduces dementia in patients with hypertension

CRHCP Dementia – Effectiveness of Blood Pressure-Lowering Intervention on Risk of Total Dementia Among Patients With Hypertension: A Cluster-Randomized Effectiveness Trial

Presented at the AHA Scientific Sessions 2023 by: Jiang He, MD, PhD - New Orleans, LA, US

Introduction and methods

Due to the lack of curative therapies for dementia, the focus should be on primary prevention of dementia through risk factor reduction, such as BP lowering. Previous RCTs however have not shown reduction in dementia with antihypertensive treatment in patients with hypertension or stroke. This could be due to insufficient duration or sample size of the trials.

In the CRHCP Dementia trial, the efficacy of intensive BP lowering compared to usual care was examined with regard to reducing the risk of all-cause dementia and cognitive impairment in patients with hypertension over a 48-month intervention period.

This was an open-label, blinded-endpoint, cluster-randomized trial in which 33,995 individuals ≥40 years with uncontrolled hypertension from 326 villages in China were enrolled. Randomization occurred at the village level. Village doctors initiated and titrated antihypertensive medication to achieve BP goal of <130/80 mmHg with supervision of primary care physicians. These doctors distributed the antihypertensive medications, provided coaching for lifestyle modification and medication adherence and offered guidance on home BP monitoring for patients.

The primary outcome was all-cause dementia (adjudicated by an expert panel blinded to the intervention assignment).

Main results

• SBP decreased from 157.0 mmHg at baseline to 127.6 mmHg at 48 months in the intervention group, and from 155.4 mmHg to 147.7 mmHg at 48 months in the control group (net reduction of 22 mmHg).
• At 48 months, 67.7% of participants in the intervention group achieved a BP of <130/80 mmHg and 15.0% in the control group.
• At 48 months, there were 668 dementia events (1.12% per year) in the intervention group and 734 dementia events (1.31% per year) in the control group (RR 0.85, P=0.0035).
• Cognitive impairment (no dementia) was also reduced in the intervention group compared with the control group (RR 0.84, P<0.0001), as well as composite endpoints of dementia or cognitive impairment and dementia or death.
• Serious adverse events were lower in the intervention group compared with the control group (9.16% per year vs. 9.86% per year, P=0.0006).

Conclusion

In the CRHCP Dementia trial, BP lowering was effective in reducing the risk of dementia after 48 months in patients with hypertension in China.

Jiang He concluded: ‘This proven-effective intervention should be widely scaled up to reduce the global burden of dementia.’

- Our reporting is based on the information provided at the AHA Scientific Session 2023 -