2023-11-16 11:41:30
Philadelphia – A 4-year blood pressure reduction intervention program in China has resulted in a 22 mmHg reduction in systolic blood pressure in patients with hypertension. The risk of all-cause dementia decreased by 15% and cognitive impairment without dementia by 16% compared to standard treatment. These results of a cluster-randomized study were presented by Prof. Dr. Jiang He, director of the Tulane Translational Science Institute at the University of New Orleans, presented at the American Heart Association’s 2023 Scientific Sessions [1].
Prof. Dr. Jiang He
“This is the first large, randomized trial to show that lowering blood pressure is effective in reducing the risk of dementia in people with high blood pressure,” He said. “The results highlight the importance of widespread adoption of more intensive blood pressure control to reduce the global burden of dementia.”
Meaningful study results
At a press conference, Prof. Dr. Keith Ferdinand, Tulane University New Orleans, described the study as “very meaningful”. It included a large number of participants and achieved convincing p-values.
Also discussant Dr. Daniel Jones, University of Mississippi, Jackson, said: “This is the first definitive evidence of dementia risk reduction from a randomized trial.” He called it “world-changing data.” Dementia is increasing around the world, so it’s great that we now have a tool for prevention.
However, these results now need to be confirmed; They have not yet been intensively examined. It is also unclear whether intensive blood pressure reduction can reduce the risk of all forms of dementia and whether earlier treatment might have even better effects.
Treatment by rural doctors in China
A look at details: The open, cluster-randomized study enrolled 33,995 people aged 40 and over with uncontrolled hypertension in 326 villages in China. 163 villages each were assigned to the intervention group and the control group, stratified by province, district and municipality.
In the intervention group, trained rural doctors initiated treatment with antihypertensive medication. They titrated blood pressure using a simple step protocol to achieve a value <130/80 mmHg. In addition, they distributed discounted or free antihypertensive medications, offered health advice on lifestyle changes and adherence, and helped patients measure blood pressure at home.
The rural doctors were monitored and advised by specialists and specialists. Participants in the comparison group were treated with standard therapy.
After 4 years, the participants were examined by neurologists and tested with various tests. The doctors did not know which group patients belonged to.
The primary endpoint was all-cause dementia, and the main secondary endpoint was cognitive impairment without dementia (CIND). The final diagnosis of dementia or CIND was made by an expert panel blinded to randomization.
Overall, 91.3% of participants completed the study completely. They were on average 63 years old; 61% were women.
Primary endpoint achieved
After 4 years, systolic blood pressure fell from 157 mmHg to 127.6 mmHg in the intervention group and from 155.4 mmHg to 147.7 mmHg in the control group. The net reduction in the verum group was 22 mmHg. Diastolic blood pressure decreased from 87.9 mmHg to 72.6 mmHg with intervention and from 87.2 mmHg to 81.0 mmHg in the control group. The net reduction was 9.3 mmHg.
In the intervention group, 67.7% of participants achieved the target blood pressure of less than 130/80 mmHg; in the control group it was 15.0%.
Participants in the intervention group received an average of 3 antihypertensive medications, while in the control group it was an average of 1.2. Calcium channel blockers (86.8% vs. 53.3%), diuretics (63.8% vs. 10.8%), ACE inhibitors (50.3% vs. 6.3%) and angiotensin receptor blockers (30 .1% vs. 32.3%). Adherence was 88.0% in the intervention group and 66.4% in the comparison group.
Intensive blood pressure reduction reduced the risk of all-cause dementia by 15% and the risk of cognitive impairment without dementia by 16%. This effect was independent of age, gender, education, smoking, BMI, systolic blood pressure and fasting blood glucose level.
All results are summarized in Table 1.
Endpoints
Intervention group
Standard therapy
Relatives
Risk
p-value
events [n]
rate per year [%]
events [n]
rate per year [%]
All-cause dementia (primary endpoint)
668
1,12
734
1,31
0,85
0,0035
Cognitive disorder without dementia (second endpoint)
2.506
4,19
2.808
5,02
0,84
<0,0001
Dementia or cognitive disorder
3.174
5,31
3.542
6,34
0,84
<0,0001
dementia or death
1.908
3,04
2.092
3,54
0,86
<0,0001
Severe side effects
6.201
9,16
6.329
9,86
0,94
0,0006
Table 1: Effect of blood pressure reduction on primary, secondary and safety endpoints in CRHCP [1].
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