China Rural Hypertension Control Project (CRHCP) — Effectiveness of a Standardized Protocol-based Treatment Program on Hypertension Control in Rural China

CRHCP

Patient / Population Intervention / Exposure Comparison Outcome

In 33,995 rural Chinese adults with hypertension, village-doctor-led intensive blood-pressure control reduced all-cause dementia compared with usual care.

N

33,995patients

Design

Open-label, cluster-randomised, blinded-endpoint trial; 326 villages in rural China randomised 1:1 (163 villages to intervention, 163 to usual care); village doctor-led multifaceted intervention (protocol-based antihypertensive initiation and titration to a target <130/80 mmHg, home BP monitoring, health coaching, specialist supervision, performance-based incentives) versus usual care; phased primary outcomes at 18 months (BP control), 36 months (composite CVD) and 48 months (all-cause dementia), with an extension study to year 7; outcome assessment committee blinded.

Endpoint

All-cause dementia (Phase 3 primary outcome, assessed at 48 months after baseline); the Hot Line presentation covers longer-term follow-up of BP control and dementia risk

Relevance

1Practice-defining — the trial the guideline rests on.

ResultDementia occurred in 8.85% vs 10.55% over seven years (adjusted risk ratio 0.85, 95% CI 0.78-0.91; P < 0.001), a 15% relative reduction. Cognitive impairment without dementia was 13% less frequent (P < 0.001). Systolic pressure fell 17.6 vs 2.4 mmHg. Serious adverse events 47.15% vs 49.78%.

Zhong S, et al. Presented at ESC Congress 2026, Hot Line 9, 30 August.

Discussion & critique

Blood-pressure lowering has reduced stroke for decades while dementia stayed a hope; this is the largest randomised evidence that it reduces dementia too, in 34,000 people over seven years and with a 15 mmHg separation to explain it. The intervention is a village health worker following a stepped protocol, not a drug — so what is shown is that a system delivering the treatment reaches an outcome, which is also why the result travels less easily than a pill would. Open-label with adjudicated endpoints, four active years and three of observation; the effect is modest in absolute terms, 1.7 percentage points, and it is the first of its size to be positive.