Takeaway
Orthostatic hypotension, but not supine hypertension, is associated with global and regional brain atrophy which is more pronounced in severe hypotension.
Why this matters
These important findings support the existence of a direct hemodynamic impact of orthostatic hypotension on specific cortical areas. The observed atrophy could represent a unique phenotype of people with orthostatic hypotension which is characterized by extensive progression of Lewy body pathology. Ultimately, vasopressor agents could be used to reduce brain atrophy for better clinical outcomes.