Abstract: Objective To investigate the relationship between orthostatic hypotension and major cardiovascular diseases, including heart failure, coronary heart disease (CHD), and stroke. Methods The literature on the relationship between orthostatic hypotension and major cardiovascular diseases was systematically searched using databases such as PubMed, Web of Science, Cochrane Library, CNKI (China National Knowledge Infrastructure), VIP database, and Wanfang Data Knowledge Service Platform from inception up to November 30, 2023. A meta-analysis was conducted using hazard ratios (HR) value as statistics. Results Six prospective studies were included in this meta-analysis. The follow-up time was 3 to 26 years. The quality scores of included literature were all ≥4, indicating a high-quality level. The meta-analysis results showed that orthostatic hypotension increased the risk of heart failure (HR=1.37, 95%CI: 1.24-1.52), CHD (HR=1.47, 95%CI: 1.04-2.07), and stroke (HR=1.60, 95%CI: 1.32-1.93). Subgroup analysis showed that follow-up duration was a cause of heterogeneity in the analysis for CHD. Sensitivity analysis showed that in the analysis for heart failure and stroke, the results were generally robust, while in the analysis for CHD, the result was not robust. The funnel plot for orthostatic hypotension in relation to heart failure, CHD, and stroke showed asymmetry, indicating the presence of publication bias. After correction using the trim-and-fill method, the funnel plot exhibited symmetry. Conclusion Orthostatic hypotension is potentially associated with heart failure, CHD and stroke. However, the sensitivity analysis regarding the relationship between CHD and orthostatic hypotension indicates that the results is unstable, and further research is needed.