Weekly Journal Scan: a real-world study in China shows that a tight control of blood pressure reduces all-cause dementia

This comment refers to ‘Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial’, which was published in Nature Medicine, https://doi.org/10.1038/s41591-025-03616-8. The relationship between hypertension and cognitive disorders has been described by different preclinical and clinical studies.2 Among the proposed pathophysiological mechanisms, macroscopic and microscopic remodelling of brain vasculature, consisting in the deposition of collagen and fibronectin, proliferation of smooth muscle cells, and reduction of pericyte numbers, is believed to play a pivotal role.2 On the other hand, the effects of BP-lowering medications on the risk of dementia and the benefits of an adequate BP control in preventing or slowing cognitive decline are less defined. Although not designed with the specific aim of evaluating the effects on cognitive function, previous studies failed to demonstrate a statistically significant reduction in the incidence of dementia in hypertensive patients who received BP-lowering treatments compared with placebo.3–6