Better Blood Pressure Can Help Prevent Dementia

It’s hard to think of a bigger emotional blow that sitting next to someone you’ve loved for most of your life, telling them that you love them, and have them look back blankly and ask, “Who are you again?”

Dementia is devastating and is a leading cause of death worldwide. It’s not “the long goodbye”—it’s emotional torture for those who are forced to watch their loved one slowly disappear.

Not all cases of dementia can be prevented—it’s one of the risks of our increaing longevity. But there are things we can do to improve the odds.

A couple of weeks ago I told you about some interesting new research showing a possible decrease in dementia risk among people who get their shingles vaccines. A new study out of China contains more good news: controlling blood pressure significantly reduced the risk of developing dementia.

This isn’t a surprising finding but the results were quite strong and the methods have big implications for how we practice. A significant proportion of dementia in the US is caused by Alzheimer’s and other “neurodegenerative disorders”. But a significant number are also caused by “vascular disease”. This includes strokes, and smaller stroke-like damage to the brain that accumulates over time. We already know that controlling blood pressure is important in reducing stroke risk, but this study links blood pressure control directly to lowering dementia risk.

Here’s what they did.

They assigned 163 villages (yes, that’s “villages”, not “people”—China is really big) to receive “usual care”, and another 163 village to an intervention designed to better address blood pressure. For the villages that received the intervention, non-doctors were trained to check blood pressures and adjust medications; patients were given access to free blood pressure machines; and medications were free. They also received counseling in healthy lifestyle, such as diet and exercise. It’s not clear to me if the control group received similar counseling.

What the study found is that the villagers that got the intervention showed better blood pressure control, and in the 48 months of follow up were much less likely to be diagnosed with dementia.

Now, the US isn’t China. We don’t have the equivalent of village non-doctor healthcare providers; we don’t have a centralized medical system. But we actually do have some models here that can guide us going forward.

One of the most interesting of these is something that has been studied for about the last 20 years, and targets one of our highest-risk groups.

A number of studies have looked specifically at Black-owned barbershops. In some studies, pharmacists were trained to go and talk to patrons about blood pressure. In others, the barbers themselves were trained. All of these groups showed excellent results. It turns out you have to go to where the problem is, and address it in a way people will understand and trust.1 

We don’t do a great job in the US controlling blood pressure. Hopefully this study helps underline the importance of BP control for brain health (exercise also helps control BP and helps prevent dementia). We need to get to people where they are. Without the benefit of universal health coverage, it’s too easy to fall through the cracks.

Get your blood pressure checked!

Stay well.

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Citations:

1. He, J., Zhao, C., Zhong, S. et al. Blood pressure reduction and all-cause dementia in people with uncontrolled hypertension: an open-label, blinded-endpoint, cluster-randomized trial. Nat Med (2025). https://doi.org/10.1038/s41591-025-03616-8

2. Brandon K. Bellows, PharmD, MS, et al. Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops. CirculationVolume 143, Issue 24, 15 June 2021; Pages 2384-2394 https://doi.org/10.1161/CIRCULATIONAHA.120.051683

3. Ciantel A. Blyler, PharmD, et al. Sustainability of Blood Pressure Reduction in Black Barbershops. CirculationVolume 139, Issue 1, 2 January 2019; Pages 10-19. https://doi.org/10.1161/CIRCULATIONAHA.118.038165

4. Robert M. Elashoff, Ph.D., et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018;378:1291-301. DOI: 10.1056/NEJMoa1717250

5. Victor, Ronald, et. al. Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men. HypertensionVolume 49, Issue 5, 1 May 2007; Pages 1040-1046 https://doi.org/10.1161/HYPERTENSIONAHA.106.080432