y Hypertension is a well-established risk factor for cognitive decline and dementia, including both Alzheimer disease and vascular dementia (2,142,143), and controlling blood pressure during midlife has been shown to provide greater long-term cognitive benefits compared with starting treatment in later life (2). y Although managing blood pressure supports brain health, its specific effect on dementia outcomes is difficult to isolate because of overlapping risk factors and multimorbidity. y There is no single optimal blood pressure threshold for cognitive protection. Hence, treatment should be tailored to individual risk profiles, including cardiovascular and metabolic factors. y Hypertension control is a public health and economic priority, with established treatment pathways and scalable interventions that can reduce dementia-related health care and caregiver burden. Widely available screening tools, treatment protocols and public health guidelines make the management of hypertension both feasible and effective for dementia risk reduction. y However, at the population level, a considerable treatment gap persists, with only about 44% of adults with hypertension diagnosed and treated, and just 23% achieving control globally (139). y Hypertension management should follow national and international recommendations (137,138). y Hypertension is strongly linked to cardiovascular and renal complications, including heart attacks, heart failure, stroke and kidney failure (139). Hypertension can be effectively managed through lifestyle changes, such as healthy eating – including low salt intake, physical activity and weight control – as well as antihypertensive medications (2). y Hypertension control is already embedded in many national NCD programmes; thus, existing infrastructures (especially in primary care) can be leveraged for dementia prevention through routine screening, monitoring, education and referral. For example, integrated approaches that address hypertension alongside other cardiovascular and metabolic risk factors (e.g. diabetes and obesity) are likely to be more sustainable and beneficial for overall brain and heart health. y In older people, blood pressure targets should be individualized rather than being applied uniformly. Both insufficient and overly intensive blood pressure control may lead to adverse outcomes. Treatment decisions should consider the individual’s intrinsic capacity, functional status, orthostatic symptoms and cardiovascular history, acknowledging that the benefit–risk balance of tighter blood pressure control narrows as intrinsic capacity decreases. y In LMIC, successful implementation requires health system strengthening, including reliable supply chains, access to essential medications and workforce development. y Culturally tailored education and community-based interventions are needed to reduce stigma, improve adherence and align with local beliefs and behaviours. y Digital health tools (e.g. mHealth reminders, telemonitoring and decision support systems) can enhance adherence and follow-up, particularly in remote or underserved areas. y Public health messaging should emphasize the dual benefits of hypertension control for cardiovascular and cognitive health, with a focus on early detection and midlife intervention.

Management of hypertension should be offered to all adults with hypertension, in line with WHO guidance. Clinical practice: y Guideline for the pharmacological treatment of hypertension in adults (38) y HEARTS: technical package for cardiovascular disease management in primary health care (39) Service delivery and care pathways: y WHO package of essential noncommunicable (PEN) disease interventions for primary health care (11) Public health and policy: y Global action plan for the prevention and control of noncommunicable diseases 2013–2020 (35) y Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases (12)