A groundbreaking study conducted in rural China has provided compelling evidence of the importance of intensive blood pressure control in reducing the risk of dementia and cognitive impairment. The study, a large cluster-randomized controlled trial, demonstrated that maintaining blood pressure below 130/80 mm Hg lowered the risk of dementia by 15% and cognitive impairment by 16%.
This significant finding served as the basis for a new guideline issued by leading medical groups, including the American Heart Association and the American College of Cardiology. According to Dan Jones, chair of the guideline writing committee and a past president of the American Heart Association, this study was the first to definitively show that rigorously lowering blood pressure to a goal of below 120 systolic can decrease the risk of dementia.
The new guideline, announced recently, reaffirms the target blood pressure goal of under 120/80 for all adults in the United States. Currently, nearly half of American adults have blood pressure readings exceeding 130/80. The recommendations not only emphasize the impact of hypertension on cognition but also stress the importance of early treatment and address the risks associated with high blood pressure during and after pregnancy.
Timothy Anderson, a primary care physician and assistant professor of medicine at the University of Pittsburgh Medical Center, noted that the new guideline does not introduce any drastic changes for patients but rather urges healthcare providers to continue striving for better blood pressure control. The 120/80 blood pressure level, endorsed in 2017, has stood the test of time and was validated by the latest guideline, which utilized the PREVENT risk assessment tool.
PREVENT, introduced in 2023, is considered an improvement over previous calculators due to its utilization of a larger and more diverse database. Researchers, including Anderson, have cautioned that applying this tool to manage high cholesterol could result in a significant decrease in the number of adults eligible for statins unless treatment thresholds are adjusted accordingly.
Jones explained that the 2025 blood pressure guideline, based on PREVENT, features a different treatment threshold than its predecessor. The forthcoming cholesterol guideline, slated for release in 2026, will also introduce a new threshold for initiating statin therapy for cholesterol management.
High blood pressure remains the leading risk factor for cardiovascular disease, underscoring the importance of early intervention. While maintaining blood pressure below 120 is optimal, the new recommendations advise initiating treatment to lower the top number below 130 for individuals with hypertension. Lifestyle modifications, such as improved diet, regular exercise, and blood pressure monitoring, are recommended as initial preventive measures. If these lifestyle changes do not yield significant improvements, healthcare providers are advised to initiate pharmacological treatment within three to six months.
The guideline also recommends combining two blood pressure medications in certain cases and suggests low-dose aspirin for pregnant individuals. Addressing elevated blood pressure during pregnancy is crucial, as it is linked to long-term risks of hypertension and cardiovascular disease. By incorporating guidance on low-dose aspirin use to reduce the risk of pre-eclampsia and eclampsia, the guideline aims to raise awareness among primary care physicians about the importance of blood pressure management during pregnancy.
In addition to pharmacological interventions, the guideline suggests considering obesity drugs like GLP-1s for blood pressure management. Weight loss, whether achieved through lifestyle modifications or medication, is an effective strategy for reducing blood pressure. Potassium-enriched salt substitutes and potassium-rich foods are recommended to help lower sodium intake and promote overall cardiovascular health.
Jones emphasized the importance of reducing salt intake in the diet, recommending a daily limit of 1,500 mg and advocating for the consumption of potassium-rich foods. While evidence from China may not directly apply to American dietary habits, Jones highlighted the need for individuals to be mindful of sodium content in restaurant and processed foods.
In conclusion, the new guideline on blood pressure management underscores the critical role of intensive blood pressure control in reducing the risk of dementia and cognitive impairment. By emphasizing early treatment, lifestyle modifications, and medication options, healthcare providers can help individuals achieve optimal blood pressure levels and mitigate the risks associated with hypertension.
