Chinese Trial Finds Intensive Blood Pressure Control Below 120 mm Hg Safe for Cognitive Function in 11,000 Hypertension Patients
A Chinese multicenter trial involving more than 11,000 hypertensive patients aged 60 to 80 found that intensive blood pressure control below 120 mm Hg was safe for cognitive function. According to researchers, the STEP trial showed no decline in cognitive performance and reduced cardiovascular events compared with standard blood pressure targets.
The STEP trial, a multicenter, randomized controlled study conducted in China, enrolled more than 11,000 hypertensive patients aged 60 to 80 years to compare intensive versus standard systolic blood pressure (SBP) targets, according to the study published Monday in the American Heart Association journal Hypertension. Participants were randomly assigned in a 1:1 ratio to an intensive SBP goal of 110 to 130 mm Hg or a standard SBP target of 130 to 150 mm Hg, officials said. The primary outcome was the annual change in cognitive function measured by the Mini-Mental State Examination (MMSE), with additional assessments of cardiovascular events.
Researchers found that intensive SBP control below 120 mm Hg was safe for cognitive function, showing no deterioration in global cognitive performance as measured by MMSE scores, according to the trial results.
The intensive treatment group also experienced a lower incidence of cardiovascular events compared with the standard treatment group, sources confirmed. These findings were consistent regardless of participants’ baseline diastolic blood pressure levels, although those with the lowest diastolic pressure had higher rates of cognitive decline overall. Despite this, the intensive group still showed better cognitive outcomes.
The trial further indicated a reduced risk of probable dementia or mild cognitive impairment among those in the intensive treatment group, officials said. This aligns with results from the SPRINT MIND trial, a U.S.-based study led by Wake Forest University School of Medicine, which also demonstrated cognitive benefits from intensive blood pressure control. David M. Reboussin, Ph.D., corresponding author of the SPRINT MIND secondary analysis, noted that intensive SBP control has been linked to improved verbal fluency and processing speed after adjusting for age and demographic factors.
The STEP trial’s participants were specifically Chinese hypertensive patients aged 60 to 80 years, a group often excluded from similar studies due to comorbidities such as diabetes, prior stroke, or heart failure, according to trial documentation. This contrasts with the SPRINT MIND trial, which enrolled 9,361 participants aged 50 and older across more than 100 sites in the U.S. and Puerto Rico. The SPRINT trial was terminated early after a median follow-up of 3.3 years due to significant cardiovascular benefits observed in the intensive treatment arm, including a 38% reduction in heart failure risk, a 43% reduction in cardiovascular death, and a 27% reduction in all-cause mortality, records show.
Cognitive assessments in the STEP trial were conducted at baseline and during follow-up visits, using MMSE to categorize participants into no impairment, mild cognitive impairment, or probable dementia groups. Similarly, SPRINT MIND employed in-person and telephone cognitive testing over a median of seven years, with results published in Neurology in February 2025 confirming sustained cognitive benefits for at least five years post-treatment.
The STEP trial’s findings contribute to a growing body of evidence supporting intensive blood pressure management in older adults to mitigate cardiovascular and cognitive risks. The trial was conducted across multiple centers in China and published in 2023, while the SPRINT MIND secondary analysis was released on January 21, 2025, by Wake Forest University. Both studies received support from the National Institutes of Health and involved collaboration among leading cardiovascular and neurological researchers.
Current hypertension guidelines define hypertension as blood pressure readings of 140/90 mm Hg or higher, with prehypertension classified between 120/80 and 139/89 mm Hg. The STEP and SPRINT trials’ intensive targets of below 120 mm Hg challenge these thresholds by demonstrating safety and efficacy in older populations. The ongoing analysis of long-term cognitive and cardiovascular outcomes aims to inform future clinical recommendations for blood pressure management in aging adults.
