The impact of intensive blood pressure (BP) control on cognitive function in East Asian populations remains uncertain. We aimed to assess the effect of a lower systolic BP target on global cognitive function in Chinese hypertensive adults. This secondary analysis of a randomized trial involved hypertensive patients with high cardiovascular risk across 116 sites in China. Participants were assigned to receive intensive treatment (systolic BP target <120 mm Hg) or standard treatment (systolic BP target <140 mm Hg) for a median of 3.4 years. Cognitive function was assessed via MMSE (Mini-Mental State Examination) at baseline and the end of the study. Prespecified outcomes were a change in MMSE score and investigator-reported probable dementia. Among 11 255 randomized participants, all completed cognitive assessment at baseline and 10 440 (92.8%) at the end of the study. The mean change in MMSE score was not significantly different between arms (difference, 0.05 [95% CI, -0.07 to 0.17]), with a mean change of -0.54 (95% CI, -0.63 to -0.46) in the intensive arm and -0.60 (95% CI, -0.68 to -0.51) in the standard arm. Results were robust across sensitivity analyses and consistent across most subgroups. Exceptions included subgroups of coronary heart disease or antiplatelet treatment. The incidence of probable dementia was too low for meaningful interpretation. Intensive systolic BP lowering to a target of <120 mm Hg for 3 years did not adversely affect global cognitive function in Chinese hypertensive adults, irrespective of age, sex, BP level, and comorbidities, affirming the cognitive safety of this treatment strategy. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04030234.
