PDE5 inhibitors increased cerebral blood flow in white matter hyperintensity regions in adults with cerebral small vessel disease.

A systematic review and meta-analysis assessed the effects of phosphodiesterase-5 inhibitors, specifically sildenafil or tadalafil, compared with placebo in a population of 236 adults diagnosed with cerebral small vessel disease. The study design details regarding individual trial methodologies were not reported, and the overall certainty of the evidence was not explicitly graded in the provided data. The primary outcomes examined included changes in cerebral blood flow within white matter hyperintensity regions, mean flow velocity in the middle cerebral artery, and performance on standardized cognitive assessments. Secondary outcomes included diastolic blood pressure measurements.

Regarding the primary outcomes, the meta-analysis demonstrated a statistically significant increase in cerebral blood flow in white matter hyperintensity regions, with a mean difference of 1.31 mL/100 g/min (95% CI: 0.46–2.15; p = 0.002). In contrast, the mean flow velocity in the middle cerebral artery did not reach statistical significance (p > 0.05). For the secondary outcome, diastolic blood pressure showed a modest reduction, with a mean difference of -4.65 mmHg (95% CI: -5.96 to -3.34; p < 0.05).

Safety and tolerability data were not reported for adverse events, serious adverse events, discontinuations, or overall tolerability within the provided evidence. Key limitations include the absence of reported follow-up duration and the lack of specific details on the setting or funding sources. The practice relevance was not explicitly detailed in the input data. Given the absence of safety information and the specific limitations of the included studies, the clinical application of these findings remains uncertain.