Title: Is Hypertension Negatively Associated with Memory Performance in Women During
Climacteric? A Systematic Review
Version: 1 Date: 12 Jul 2024
Reviewer:  Ananthan Ambikairajah
Reviewer's report:
In this paper, the authors investigate the association between hypertension and memory
performance in women across the stages of reproductive ageing. The use of a systematic review
to address the question of interest is a key strength of the paper. Further clarification and
justification regarding the methodology, analyses and reporting of results is required.
- It is important to report more than whether an association was found in studies, but also the
direction of the associations. This has not been done in the abstract.
- Eligibility/Exclusion criteria needs further clarity i.e. how was middle age defined. Also not
clear why studies with male participants were excluded if women were also included in the study
and data from the women could have been extracted in some. Instead, it would make sense to
exclude studies with only male participants, but not those that had both women and men.
- A core component of systematic reviews is replicability. The current search strategy requires
further clarification for replicability i.e. what was the exact search string used and which boolean
operators were used? Also the use of * is not used correctly. If trying to capture the variations
of words, the asterisks needs to be placed before the differences in words occur. For example,
rather than menopause* as currently stated, the term should be menopaus*, to capture both
"menopause" and "menopausal". As currently written, only menopause will be captured. This
likely led to the low number of titles retrieved for this topic.
- It is also not clear why "premenopause" is left off the search string given the aim focuses on
performance in women during reproductive ageing, which includes premenopause and actually,
by definition also includes menarche. There appear to be major issues with the search string
which questions whether the literature has been systematically reviewed in an appropriate way
that captures all relevant articles relating to this topic. A quick search of google reveals several
studies that could be included, yet have not been even referenced/discussed in the manuscript,
including:
- Zilberman, J. M., Cerezo, G. H., Del Sueldo, M., Fernandez#Pérez, C., Martell#Claros, N.,
& Vicario, A. (2015). Association between hypertension, menopause, and cognition in women.
The Journal of Clinical Hypertension, 17(12), 970-976.
- Chou, C. C., Chien, L. Y., Lin, M. F., & Wang, C. J. (2021). Cognitive function and associated
factors among postmenopausal women with hypertension and natural menopause in Taiwan.
Geriatric Nursing, 42(1), 110-116.
- In data extraction, was medication history for hypertension recorded? If not, why?
- Please provide a completed PRISMA checklist. There seem to be sections missing, for example,
19 "For all outcomes, present, for each study: (a) summary statistics for each group (where
appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval),
ideally using structured tables or plots" - I cannot see any effect sizes reported with confidence
intervals for individual studies.