Could Aggressive Blood Pressure Control Save Your Brain?

A new study suggests that aggressive blood pressure control may have benefits for cognitive function. Scientists reached that conclusion from a large Chinese study published in Nature Medicine, April 21, 2025. The researchers randomized 30,000 participants for the trial. All hypertensive patients received blood pressure medications, but half of the villages were randomized to receive more intensive treatment. The goal of this aggressive blood pressure control was to achieve systolic blood pressure under 130 and diastolic blood pressure under 80.

At the end of four years, those in the intensive treatment group were less likely to have developed dementia. The relative risk reduction was 15%. The absolute risk reduction was about 1%. The non-physician coaches in the intervention villages helped people stick to their medications, reduce their salt intake, drink less alcohol and lose weight. In the control villages, people took similar medications but received no coaching. The adherence with the program was 88% in the intervention villages and 66% in the control villages.

Headlines Hype Chinese Research:

“Reducing High Blood Pressure Can Cut Risk of Dementia” (New Scientist, April 21, 2025)

“Common Intervention Lowers Dementia Risk, Trial Shows” (MEDPAGE Today, April 21, 2025)

“Shocking New Study Finds Common Blood Pressure Pills Slash Dementia Risk by 15%” (The Mirror, April 23, 2025)

Drilling Down on the Data:

A 15% reduction in dementia risk certainly seems impressive. But we must emphasize that is a relative risk reduction. It always seems exciting until you look at the absolute risk reduction. In this case that was 1%.

But most people have a hard time distinguishing between these two key metrics. That’s why we like to provide actual numbers. The study in Nature Medicine, April 21, 2025 offers us hard numbers. Remember, there were 33,995 participants in the study. That breaks down to 17,407 people in 163 intervention villages and 16,588 participants in 163 usual care villages.

Dementia was diagnosed in 4.59% of those volunteers in the intensive BP treatment group.

Dementia was diagnosed in 5.40% of those volunteers in the usual care BP treatment group.

In absolute numbers, 668 participants in the high-intensity blood pressure control group were diagnosed with dementia and 734 participants were diagnosed with dementia in the usual care group.

And that, dear reader, is why we provide absolute risk reduction along with relative risk reduction. A casual reader sees a headline that says “Blood Pressure Pills Slash Dementia Risk by 15%” and is quite impressed. That person might go so far as to calculate 15% of the 17,407 people in the intensive treatment group and come up with 2,611 who would have been spared dementia. That would be impressive.

Those who dig deeper, however, would discover that the difference between intensive treatment vs regular BP treatment was actually 66 fewer people who were diagnosed with dementia. And now you know why scientists like to emphasize relative risk over absolute risk reduction.

Another Study Looked at Intensive vs Standard BP Treatment:

The Chinese research comparing “intense” blood pressure management with “usual care” hypertension control was not the only study to look at dementia outcomes. A study published in JAMA by the SPRINT MIND Investigators (Jan. 28, 2019) asked an important question:

“Does intensive blood pressure control reduce the occurrence of dementia?”

The SPRINT study was a follow-up on a clinical trial that originally showed getting systolic blood pressure to 120 could prevent some heart attacks and strokes.

How Well Did Aggressive Blood Pressure Control Work?

In 2010, researchers recruited 9,300 people over 50 to participate in the SPRINT trial. This stands for Systolic Blood Pressure Intervention Trial. The participants all had high blood pressure. However, none had diabetes or cognitive dysfunction when the study began.

The investigators randomly assigned these volunteers to get their blood pressure down to 120 (intensive blood pressure control) or under 140 (standard control). The group on standard treatment served as the control group for the trial.

Those who were assigned to intensive blood pressure control were prescribed as many drugs as were necessary to achieve the goal. Some subjects took as many as three or four different medications (SPRINT Research Group, New England Journal of Medicine, Nov. 26, 2015).

This secondary study was dubbed SPRINT MIND. The volunteers participated in cognitive tests both at baseline and after three to five years of treatment.

The Results of SPRINT MIND:

People in the intensive blood pressure control arm were slightly less likely to develop dementia during the five years of the study. Unfortunately, the difference was too small to be statistically significant. There were 149 cases of dementia in the aggressive blood pressure control arm. In comparison, 176 in the standard treatment group developed dementia. That works out to 7.2 per 1,000 person-years for the intervention. Conversely, the rate was 8.6 cases/1,000 person-years in the control group.

Mild cognitive impairment is a less severe problem, but it’s more common. This complication occurred in 14.6 cases per 1000 person-years in the intensive treatment arm. People in the standard treatment arm had a rate of mild cognitive impairment of 18.3 per 1000 person-years. Unlike the results on dementia, this difference was statistically significant. The relative risk reduction was 19 percent, but absolute risk dropped by a modest 0.4 percent. Once again, you begin to see why we keep emphasizing absolute risk as a more meaningful metric.

The authors concluded that:

“Among adults with hypertension, intensive blood pressure control did not significantly reduce the risk of probable dementia.”

They speculated that the study may have been underpowered to detect the influence of aggressive blood pressure control on dementia. Nonetheless, that still suggests that any effect that might have been missed is probably not very large.

A follow-up analysis was published in the journal Neurology, Jan. 16, 2025. The original cognitive assessment was carried out through 2018. A follow-up assessment started in 2019. The investigators discovered 216 new cases of “probable dementia.”

Their new calculations:

“Over a median follow-up of 7 years, 248 participants of the intensive treatment group (8.5 per 1,000 person-years) were adjudicated with probable dementia, compared with 293 participants (10.2 per 1,000 person-years) in the standard treatment group.”

Modest at best and not statistically significant.

Final Words:

Blood pressure control is important. If you listen to our interview with Matthew Schrag, MD, PhD, you will discover that elevated blood pressure is an important risk factor for stroke. Here is a link to that podcast:

“Show 1413: Stopping Strokes: How to Reduce Your Risk of a Brain Attack”

You may also find our eGuide to Blood Pressure Solutions of interest. It can located under the Health eGuides tab.

If you think our interpretation of the latest Chinese data is worth sharing, please send a copy of friends and family. Thank you for your support.