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Orthostatic hypotension and cerebral small vessel disease: A systematic review
Julia Hi Wiersinga1,2, Frank J Wolters3,4, Mike Jl Peters5
1Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Geriatrics, Amsterdam, The Netherlands.
Insights
Orthostatic hypotension (OH) is common in older adults and may link to cognitive decline via cerebral small vessel disease (CSVD). Current research shows inconsistent links between OH and CSVD markers like white matter hyperintensities.
Area of Science:
- Neurology
- Geriatrics
- Cardiovascular Medicine
Background:
- Orthostatic hypotension (OH) is highly prevalent in aging populations.
- OH may contribute to cognitive decline through cerebral small vessel disease (CSVD).
- Existing research on the OH-CSVD association is fragmented and inconsistent.
Purpose of the Study:
- To systematically review and synthesize evidence on the association between orthostatic hypotension and cerebral small vessel disease.
- To evaluate the quality of existing studies and identify research gaps.
Main Methods:
- Systematic literature review of studies published until December 1st, 2023, in MEDLINE, PubMed, and Web of Science.
- Inclusion of studies with participants aged ≥60, assessing OH in relation to CSVD markers (white matter hyperintensities, lacunes, cerebral microbleeds).
- Risk of bias assessment using the modified JBI checklist and narrative synthesis of results.
Main Results:
- Eighteen studies were included from 3180 identified.
- Six of fifteen studies on white matter hyperintensities (WMH) found an association with OH; no longitudinal studies showed WMH progression.
- Inconsistent findings were reported for lacunes and microbleeds; adequate systolic blood pressure adjustment correlated with smaller effect sizes.
Conclusions:
- Current evidence on the OH-CSVD association is primarily from cross-sectional studies, yielding inconsistent and inconclusive results.
- Longitudinal studies with standardized assessments of OH and CSVD, and appropriate blood pressure adjustments, are needed.
- Further research is warranted to clarify the relationship between OH and CSVD in older adults.
Abstract:
Orthostatic hypotension(OH) is highly prevalent in ageing populations and may contribute to cognitive decline through cerebral small vessel disease(CSVD). Research on the association between OH and CSVD is fragmented and inconsistent. We systematically reviewed the literature for studies assessing the association between OH and CSVD, published until December 1st 2023 in MEDLINE, PubMed or Web of Science. We included studies with populations aged ≥60, that assessed OH in relation to CSVD including white matter hyperintensities(WMH), lacunes and cerebral microbleeds. Modified JBI checklist was used to assess risk of bias. A narrative synthesis of the results was presented. Of 3180 identified studies, eighteen were included. Fifteen studies reported on WMH, four on lacunes, seven on microbleeds. Six of fifteen studies on WMH found that OH was related to an increased burden of WMH, neither longitudinal studies found associations with WMH progression. Findings were inconsistent across studies concerning lacunes and microbleeds. Across outcomes, adequate adjustment for systolic blood pressure tended to coincide with smaller effect estimates. Current evidence on the OH-CSVD association originates mostly from cross-sectional studies, providing inconsistent and inconclusive results. Longitudinal studies using standardized and fine-grained assessment of OH and CSVD and adequate adjustment for supine blood pressure are warranted.
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