Another reason to lower blood pressure: reduced risk of dementia
A groundbreaking study conducted in rural China has shed new light on the importance of intensive blood pressure control in reducing the risk of dementia and cognitive impairment. The large-scale cluster-randomized controlled trial revealed that maintaining blood pressure levels below 130/80 mm Hg led to a 15% decrease in dementia risk and a 16% reduction in cognitive impairment.
This compelling evidence served as the cornerstone for the development of a new guideline by prominent medical organizations on the treatment of high blood pressure. Dan Jones, chair of the guideline writing committee and a former president of the American Heart Association, emphasized the significance of the Chinese study in definitively demonstrating that rigorous blood pressure lowering, with a target below 120 systolic, can lower the risk of dementia.
The recommendations put forth by the American Heart Association and the American College of Cardiology establish under 120/80 as the optimal blood pressure goal for all adults in the United States, a departure from the previous threshold of 130/80 that nearly half of American adults currently exceed. In addition to highlighting the impact of hypertension on cognition, the guidelines advocate for earlier treatment and underscore the risks associated with high blood pressure during pregnancy.
According to Timothy Anderson, a primary care physician and assistant professor of medicine at the University of Pittsburgh Medical Center, the new advice does not necessitate additional instructions for patients but rather emphasizes the importance of healthcare providers striving to achieve existing treatment goals more effectively.
The 120/80 blood pressure level, endorsed as the “new normal” in 2017, was reaffirmed in the 2025 guideline, which was based on the PREVENT risk assessment tool. Released in 2023, PREVENT represents an advancement in risk calculation methodologies due to its utilization of a larger and more diverse database.
Jones revealed that the 2025 blood pressure guideline, derived from PREVENT, introduced a different treatment threshold compared to the 2017 guidelines. Similarly, the forthcoming 2026 cholesterol guideline will incorporate a revised threshold for determining statin eligibility based on cholesterol levels.
While high cholesterol poses a significant health risk, high blood pressure remains the primary risk factor for cardiovascular diseases such as heart attack, stroke, heart failure, and kidney disease, as well as dementia. The new recommendations advise initiating treatment to lower blood pressure below 130, the threshold for stage 1 hypertension, in individuals with elevated blood pressure.
Physicians are encouraged to prescribe lifestyle modifications such as improved diet, regular exercise, and frequent blood pressure monitoring to individuals with elevated blood pressure. If lifestyle changes do not yield improvements within three to six months, treatment initiation to lower blood pressure is recommended. In some cases, a combination of two blood pressure medications may be necessary, and low-dose aspirin is advised during pregnancy.
Jones emphasized the importance of sodium intake in the diet, reaffirming the ideal limit of 1,500 mg per day and suggesting the incorporation of potassium-enriched salt substitutes and potassium-rich foods to help lower blood pressure. Potassium aids in sodium excretion from the body and relaxes blood vessel walls, leading to reduced blood pressure levels.
In conclusion, the new guidelines underscore the critical role of intensive blood pressure control in reducing the risk of dementia and cognitive impairment. By implementing these recommendations, healthcare providers can effectively address the growing burden of high blood pressure and its associated health complications.
