He Jiang, Zhao Chuansheng, Zhong Shanshan, Ouyang Nanxiang, Sun Guozhe, Qiao Lixia, Yang Ruihai, Zhao Chunxia, Liu Huayan, Teng Weiyu, Liu Xu, Wang Chang, Liu Songyue, Chen Chung-Shiuan, Williamson Jeff D, Sun Yingxian
Department of Epidemiology, Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Nat Med. 2025 Apr 21. doi: 10.1038/s41591-025-03616-8.
Dementia is a leading cause of death and disability worldwide. Here we tested the effectiveness of blood pressure (BP) reduction on the risk of all-cause dementia among 33,995 individuals aged ≥40 years with uncontrolled hypertension in rural China. We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care. In the intervention group, trained non-physician community healthcare providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP goal of <130 mm Hg and a diastolic BP goal of <80 mm Hg, with supervision from primary care physicians. Over 48 months, the net reduction in systolic BP was 22.0 mm Hg (95% confidence interval (CI) 20.6 to 23.4; P < 0.0001) and that in diastolic BP was 9.3 mm Hg (95% CI 8.7 to 10.0; P < 0.0001) in the intervention group compared to usual care. The primary outcome of all-cause dementia was significantly lower in the intervention group than in the usual care group (risk ratio: 0.85; 95% CI 0.76 to 0.95; P = 0.0035). Additionally, serious adverse events occurred less frequently in the intervention group (risk ratio: 0.94; 95% CI 0.91 to 0.98; P = 0.0006). This cluster-randomized trial indicates that intensive BP reduction is effective in lowering the risk of all-cause dementia in patients with hypertension. ClinicalTrials.gov: NCT03527719 .
痴呆症是全球死亡和残疾的主要原因。在此，我们在中国农村地区33995名年龄≥40岁且高血压未得到控制的个体中，测试了降低血压（BP）对全因痴呆风险的影响。我们将163个村庄随机分配至由非医师社区医疗服务提供者主导的干预组，163个村庄为常规护理组。在干预组中，经过培训的非医师社区医疗服务提供者根据简单的逐步护理方案启动并调整降压药物，以实现收缩压目标<130 mmHg和舒张压目标<80 mmHg，并接受初级保健医生的监督。在48个月期间，与常规护理相比，干预组收缩压的净降低值为22.0 mmHg（95%置信区间（CI）20.6至23.4；P<0.0001），舒张压的净降低值为9.3 mmHg（95%CI 8.7至10.0；P<0.0001）。干预组全因痴呆的主要结局显著低于常规护理组（风险比：0.85；95%CI 0.76至0.95；P = 0.0035）。此外，干预组严重不良事件的发生频率较低（风险比：0.94；95%CI 0.91至0.98；P = 0.0006）。这项整群随机试验表明，强化降压可有效降低高血压患者全因痴呆的风险。ClinicalTrials.gov：NCT03527719 。
