Experts hail findings as a ‘wake-up call’ to seize on the vital treatment in the more than 14 million Brits with hypertension who are at greater dementia risk
Blood pressure drugs cut the risk of mental decline and dementia, a landmark study has shown.
A huge four-year clinical trial has shown effectively lowering blood pressure to 130/80mmHg reduces the risk of developing dementia by 15%. The University of Texas study of 34,000 Chinese people looked at the impact of medication and lifestyle coaching on people with high blood pressure. Those provided this also slashed their risk of cognitive impairment – defined as difficulties with thinking, memory, language and problem-solving – by 16%.
Prof Masud Husain, neurologist at Oxford University, who was not involved in the research, said: “This is a landmark study with a very large sample size and a robust effect. It’s a wake-up call to treat high blood pressure intensively, not just to protect the heart but also the brain. In my clinic, I recommend keeping blood pressure consistently below 140/80 mmHg.”
Prof James Leiper, research director at the British Heart Foundation, said if similar effects shown in the Chinese trial were found in other populations “wider use of high blood pressure treatment in people with the condition could be recommended to fight the growing impact of dementia”.
The new clinical trial enrolled 33,995 patients with untreated high blood pressure aged over 40 in rural China and saw half given “standard care” by village doctors. This consisted of advice on blood pressure management and regularly having their levels checked. The other half of participants were also given medicines to lower their blood pressure as well as lifestyle coaching including for weight loss as well as salt and alcohol reduction.
The findings, published in the journal Nature Medicine, showed that the second group achieved better blood pressure control, with more patients reaching target levels, and were 15% less likely to be diagnosed with dementia over the four-year trial.
Prof Husain added: “Remarkably, within just four years, there was a significant reduction in the incidence of dementia by aggressively treating raised blood pressure. Although many patients and their GPs understand how important it is to treat blood pressure, they might not appreciate what a risk it poses for developing dementia.”
Prof Sir Mark Caulfield, at Queen Mary University of London, said: “These findings show that optimising blood pressure control convincingly reduces risk of dementia… this is a very emphatic outcome of a trial. This is a really major advance in dementia prevention and will transform global blood pressure guidance and prevention strategies.”
The prevalence of total hypertension increased with age from 9% of UK adults aged 16 to 44 to 60% of people over 65.
Dr Richard Oakley, associate director at Alzheimer’s Society, said: “Dementia is the UK’s biggest killer. The condition is progressive and although no single behaviour is guaranteed to prevent dementia, we know that what’s good for your heart is often also good for your head.
“This study is one of the first big trials to test whether treating high blood pressure, supported by health coaching can reduce dementia risk, and the results appear to be promising.”
Previous studies have shown that people with untreated high blood pressure have a 42% greater risk of developing dementia in their lifetime. This latest trial tested the effect of medications that reduce blood pressure on this dementia risk.
Prof Toby Richards, of the University of East London, said: “This has important ramifications for individuals. Blood Pressure can be relatively easy to measure at home enabling individuals to take control and autonomy for their health and these data show benefit in reducing the risk for developing dementia.”
Almost one in three adults in the UK has high blood pressure. The diet and lifestyle coaching in the study was delivered by traditional community health leaders who did not have formal training as doctors. Some experts have questioned whether the NHS has the resources to deliver such a tailored approach to the millions with hypertension in Britain.
Prof Ian Maidment, of Aston University, said: “This intervention was delivered by ‘village doctors’ in rural villages in China. It would require significant changes for the UK and other similar healthcare systems, although potentially community pharmacists could deliver a similar programme.”
Blood Pressure Measurements Explained
High blood pressure, also known as hypertension, can lead to serious health problems including heart attack or stroke.
High blood pressure is defined as a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg.
The American Heart Foundation explains that systolic blood pressure is the first number and refers to the pressure your blood is pushing against your artery walls when the heart beats.
Diastolic blood pressure is the second number and measures the pressure your blood is pushing against your artery walls while the heart muscle rests between beats.
A higher systolic or diastolic reading may be used to diagnose high blood pressure. But the systolic blood pressure tells more about risk factors for heart disease for people over 50.
The NHS says normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg.
High blood pressure is considered to be 135/85 or higher if your reading was taken at home, or 140/90mmHg or higher if your reading was taken at a pharmacy, GP surgery or clinic. If your reading is between 120/80mmHg and 140/90mmHg, you may be at risk of developing high blood pressure in the future. Contact your GP with any concerns.
Call 999 if your blood pressure is higher than 180/120 and you are having chest pain, shortness of breath, back pain, numbness, weakness, change in vision or difficulty speaking.
Experts say the best ways to manage high blood pressure are regular physical activity, maintain a healthy weight, manage stress, get enough sleep and cut down on salt and alcohol.