In 12,434 adults with type 2 diabetes, a lower blood pressure target did not change dementia or mild cognitive impairment rates

What the research found

A prespecified look at cognitive outcomes from the BPROAD randomized trial was published on 12 November 2026. The trial ran at 145 centers in China. Adults aged 50 or older with type 2 diabetes, raised systolic blood pressure, and higher cardiovascular risk were assigned to a target below 120 mm Hg or a target below 140 mm Hg for up to five years. Of 12,821 randomized adults, 12,434 without probable dementia at baseline entered this analysis. Mean age was 63.7 years. The enrollment floor is 50, so the age tags are 40 to 59 and 60 or older. 5,567 participants (44.8 percent) were women, so the gender tag is all. 6,219 were assigned to the lower target and 6,215 to the usual target. After one year, mean systolic pressure was 121.6 mm Hg and 133.2 mm Hg. Over a median of 3.8 years, dementia or mild cognitive impairment occurred in 747 people (3.69 per 100 person-years) and 783 people (3.89 per 100 person-years). The hazard ratio was 0.96 (95 percent CI 0.86 to 1.06, P=0.38). In a magnetic-resonance subset (428 versus 434), the lower target had a smaller rise in white-matter lesion volume (between-group difference minus 0.09 inverse-hyperbolic-sine transformed cubic centimeters, 95 percent CI minus 0.15 to minus 0.02, P=0.01). The composite cognitive outcome did not differ. Registry NCT03808311. DOI 10.1136/bmj-2026-101209. Not medical advice.

Evidence level: Clinical trial. This is among the stronger kinds of evidence, but one study rarely settles a question.

Read the original at BMJ